The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study

Background This study aimed to explore predictive factors of time below target glucose range (TBR) >= 1% among patients' characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes. Methods We conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged >= 65 years. The characteristics of the participants with TBR >= 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR >= 1%. Results In the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR >= 1%, while all three GV indices showed significant associations with TBR >= 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses. Conclusions Among elderly patients with type 2 diabetes, CV reflected TBR >= 1% most appropriately among the GV indices examined. Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017

Automated summary

Among elderly patients with type 2 diabetes, the coefficient of variation (CV) is the most appropriate index that best reflects TBR >= 1% among the glycemic variability (GV) indices examined. Clinical characteristics including HbA1c and C-peptide index were not independent markers for TBR >= 1% in the multivariate logistic regression analysis, while all three GV indices showed significant associations with TBR >= 1%.