CGM-based metrics and mortality in older adults living with type 2 diabetes on insulin therapy: a secondary analysis of the HYPOAGE study - 17/06/26
ARTICLE HIGHLIGHTS |
• | Why did we undertake this study?. |
• | The relationship between continuous glucose monitoring (CGM)-derived glycemic metrics and mortality in older patients with type 2 diabetes had been little studied. |
• | What questions did we want to answer?. |
• | We wanted to determine which CGM-based glycemic targets are independently associated with all-cause mortality in older patients living with type 2 diabetes. |
• | What did we find?. |
• | Among the guidelines-defined CGM-based glycemic targets for the older people, only a coefficient of variation (CV) > 36%, reflecting glycemic variability, was significantly associated with all-cause mortality. |
• | What are the implications of our findings?. |
• | Beyond HbA1c, CGM-derived glycemic variability provides important prognostic information in older patients with type 2 diabetes on insulin therapy. Reducing glycemic variability could represent a key therapeutic goal to improve survival in this population. |
ABSTRACT |
Aim |
Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population.
Methods |
HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA 1c , kidney function, geriatric status, and metformin use.
Results |
At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio [95% CI] 1.51 [1.11; 2.06], 1.25 [1.02; 1.53], and 1.76 [1.21; 2.56] for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 [0.32; 0.99]), whereas TIR > 50% and TBR ≤ 1% were not.
Conclusion |
Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Keywords : CGM, Glycemic variability, Mortality, Older people
Plan
| Twitter summary: Beyond HbA 1c , CGM is a promising tool for to manage type 2 diabetes in older patients. Glycemic variability (CV > 36%) is an independent risk factor for all-cause mortality! #Diabetes #OlderAdults |
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