Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies

Predictors of Hypoglycemia in Patients with Type 2 Diabetes in Acute Care Settings: A Retrospective Correlational Study

BACKGROUND

Hypoglycemic episodes are among the most common adverse events experienced by hospitalized patients, occurring in up to half of all inpatients, with or without diabetes. Studies have shown that patients who have episodes of severe hypoglycemia while hospitalized have higher rates of 30-day readmission and postdischarge mortality. The Centers for Medicare and Medicaid Services considers hypoglycemic episodes to be a hospital-acquired condition. The cost burden of poor glycemic control in acute care settings is undeniably substantial.

PURPOSE

The aim of this study was to identify predictors of hypoglycemia among inpatients with type 2 diabetes.

METHODS

This retrospective descriptive correlational study involved abstracting data from 2019 to 2021 electronic health records for 600 hospitalized patients. Data were analyzed using descriptive and associative statistics and multivariate logistic regression.

RESULTS

Data analysis revealed that patients who were Asian or Hispanic, had a history of hypoglycemia, were taking both insulin and a sulfonylurea, or had a podiatric or renal admitting diagnosis had significantly higher odds of experiencing hypoglycemic episodes while hospitalized. The odds of 30-day readmission were significantly lower for patients who received diabetes self-management education, had higher glomerular filtration rates, or were admitted with a diagnosis of bone fracture.

CONCLUSION

The study findings can be used to help health care institutions design and implement more effective policies and procedures to prevent or mitigate hypoglycemic episodes.

The association of cardiometabolic multimorbidity with depression and length of hospitalization: a population-based cross-sectional study among adults in Turkey

BACKGROUND

Recent developments suggest a strong association between cardiometabolic multimorbidity, depression, and hospitalization. The aim of this study was to investigate the association of cardiometabolic multimorbidity with depression and the length of hospitalization among individuals aged 40 and older.

METHODS

This study is based on the secondary analysis of data obtained from the 2022 Turkey Health Survey conducted by the Turkish Statistical Institute (TUIK). A weighted sample of 31,425,252 individuals aged 40 and over was analyzed. The dependent variables of the study are depression and hospitalization, while the independent variable is cardiometabolic multimorbidity. Other covariates include gender, age, education level, physical activity, body mass index, tobacco use, and alcohol use. The weights from the database provided by TUIK were used in the data analysis. The relationship between cardiometabolic multimorbidity and depression was investigated using univariate and multivariate logistic regression analysis.

RESULT

Of the included participants, 51.2% were female and 35.5% were between the ages of 40-49. In Model 1, individuals with five cardiometabolic diseases had a 10-fold higher risk of developing depression compared to those with no diseases (OR: 10.0; 95% CI: 9.82-10.23). In Model 2, the risk of depression was 5.1 times higher in individuals with three diseases (OR: 5.1; 95% CI: 5.08-5.14), 5.83 times higher in those with four diseases (OR: 5.3; 95% CI: 5.78-5.88), and 14.6 times higher in individuals with five diseases (OR: 14.6; 95% CI: 14.36-14.99). Furthermore, as the number of cardiometabolic diseases increases, a significant increase in the length of hospitalization was observed (p < 0.001).

CONCLUSIONS

The findings of this study revealed that cardiometabolic multimorbidity may increase the risk of depression and the length of hospitalization in adults. These results may provide guidance for developing disease prevention and control strategies regarding cardiometabolic multimorbidity and associated factors in adults.

Predictive factors of hypoglycemia in type 2 diabetes: a prospective study using machine learning

Hypoglycemia is a serious complication in individuals with type 2 diabetes mellitus. Identifying who is most at risk remains challenging due to the non-linear relationships between hypoglycemia and its associated risk factors. The objective of this study is to evaluate the importance and impact of risk factors related to the incidence of hypoglycemia through an explainable machine learning method. This prospective study enrolled 1306 adults with type 2 diabetes mellitus at a specialized diabetes center. Over three months, participants were asked to do self-monitoring blood glucose measurements and record hypoglycemic events. Nine clinically relevant features were analyzed using five machine learning models. The performance of the models was evaluated by different metrics. The SHapley Additive exPlanation method was used to elucidate how each covariate influenced the risk of hypoglycemia. Overall, 419 participants (32.08%) reported at least one hypoglycemic episode. Our findings highlight the non-linear nature of hypoglycemia risk in individuals with T2DM. Insulin therapy, Diabetes duration (> 13.7 years), and eGFR (< 60.2 mL/min/1.73 m2) were the most important predictors of hypoglycemia, followed by age, HbA1C, triglycerides, total cholesterol, gender, and BMI.

Young adults with type 2 diabetes experience high rates of Level 3 Hypoglycemia: A subgroup analysis of the Real-World iNPHORM cohort

AIMS

This study evaluated the incidence proportion and rate of self-reported Level 3 hypoglycemia and explored associated risk factors in young adults with type 2 diabetes (T2D).

METHODS

Subgroup analyses with a one-year U.S.-wide T2D dataset were performed. Retrospective and prospective data on Level 3 hypoglycemia and participant characteristics were analyzed for 207 young adults (18-39 years old) and 436 middle-aged adults (40-64 years old). Age group-stratified multivariable negative binomial regression was used to identify factors associated with Level 3 hypoglycemia.

RESULTS

Young adults exhibited a threefold higher incidence of Level 3 hypoglycemia events requiring medical assistance compared to the middle-aged cohort at baseline (p < 0.001). During follow-up, the young adults experienced a twofold higher incidence proportion of Level 3 hypoglycemia (p < 0.001), and n a fivefold higher annualized rate (p < 0.001); they also reported greater hypoglycemia fear (p < 0.001). Distinct sociodemographics, general health and lifestyle factors, diabetes medical history, and diabetes therapy and technology use characteristics were observed in the young-adult group, as were unique risk factors for Level 3 hypoglycemia frequency CONCLUSION: Our results suggest that young adults with T2D are at particularly high risk of Level 3 hypoglycemia, with attributes that differ from those of the traditional middle-aged cohort.

Advancing Diabetes Management and Glycemic Control While Exploring CagriSema's Impact on Obesity Management

Diabetes is a complex metabolic disorder affecting over 37 million people in the United States. Without proper management, diabetes can lead to a myriad of complications, including cardiovascular disease, kidney failure, and vision loss. Obesity is a major contributor to type 2 diabetes, but genetic and physiological factors make weight loss difficult, necessitating medication management for both conditions. Government-approved weight loss medications, including glucagon-like peptide-1 agonists and amylin analogs, have proven to be effective for both conditions. However, intensive glycemic control involving antidiabetic medications, while beneficial for reducing diabetic complications, can often precipitate hypoglycemic events, which are characterized by cardiac arrhythmias, coma, confusion, and even mortality. A new drug under investigation, CagriSema, combines cagrilintide, an amylin analog, with semaglutide, a glucagon-like peptide-1 agonist. This drug is being marketed as a safe and potentially superior medication to lower both Hemoglobin A1c and body weight. In this article, the pathophysiology, current guidelines, and management of diabetes will be reviewed, with an emphasis on the clinical evidence for tight glucose control and avoiding hypoglycemic events. Following this, an overview of recent trials on antidiabetic medications, including those involving CagriSema, will be presented, along with prospects for future trials in this promising area of research.

Development and Validation of the Scale of Hypoglycemia Self-Care Behavior in Type 2 Diabetes

BACKGROUND

Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia.

OBJECTIVES

The aim of the study was to develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events.

METHODS

A cross-sectional study with purposive sampling was conducted to recruit 300 persons with Type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023.

RESULTS

The original Hypoglycemia Self-Care Behavior Scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. Validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50-.97, explaining 76% of the total variance. The four factors included "hypoglycemia recognition and carbohydrate supplementation," "prevention of hypoglycemia during exercise," "carbohydrate assessment," and "seeking medical assistance." The Hypoglycemia Self-Care Behavior Scale-developed and validated through structural equation modeling-demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73-.94, indicating strong reliability.

DISCUSSION

The Hypoglycemia Self-Care Behavior Scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical healthcare professionals but can also serve as reference for hypoglycemia-related health education.

WITHDRAWN: A Machine Learning Model for Real-Time Hypoglycemia Risk Prediction in Hospitalized Diabetic Patients: Development and Validation

The full text of this preprint has been withdrawn, as it was submitted in error. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

Differences in the insulin counterregulatory hormones between obese and nonobese male patients with type 2 diabetes mellitus

Obesity is associated with both high and low levels of hypoglycemia, and impairment of counterregulatory hormones may predispose individuals to hypoglycemia. This study aimed to explore differences in the responsiveness of insulin counterregulatory hormones to hypoglycemia between men with or without obesity who have been newly diagnosed with type 2 diabetes mellitus (T2DM). This study enrolled 25 men newly diagnosed with T2DM who were hospitalized in the Department of Endocrinology and Metabolism between January 2022 and December 2022. All participants were treated with intensive insulin pump therapy to achieve glycemic control within one week, then a hyperinsulinemic-hypoglycemic clamp was used to evaluate insulin counter-regulatory hormones for hypoglycemia. Based on the body mass index, 10 and 15 patients were included in the obese and nonobese groups, respectively. During the hyperinsulinemic-hypoglycemic clamp test, the obese group showed a significant lower multiple of adrenocorticotropic hormone elevation than the nonobese group (P = 0.040). Regarding the proportion of hormone response multiples reaching the target, those who reached the reaction multiple were lower in the obese group than those in the non-obese group, although the differences were not statistically significant (all P > 0.05). The responses of insulin counterregulatory hormones to hypoglycemia in men with obesity and newly diagnosed T2DM were significantly lower than those in men with T2DM but without obesity.

Once-Weekly Insulin Icodec Versus Once-Daily Insulin Degludec in Insulin-Naive Chinese Participants with Type 2 Diabetes: A Post Hoc Analysis of ONWARDS 3

INTRODUCTION

This post hoc analysis evaluated subgroup data from China (Chinese mainland, n = 100; Taiwan, n = 45) in ONWARDS 3, a 26-week, randomized, double-blind, double-dummy, treat-to-target, phase 3a trial comparing the efficacy and safety of once-weekly insulin icodec (icodec) versus once-daily insulin degludec (degludec) in insulin-naive participants with type 2 diabetes (T2D).

METHODS

Adults were randomized 1:1 to icodec and once-daily placebo (icodec; n = 72) or degludec and once-weekly placebo (degludec; n = 73). The primary endpoint was change in glycated hemoglobin (HbA1c) (baseline to week 26). Secondary assessments included change in fasting plasma glucose (FPG; baseline to week 26); total weekly insulin dose (weeks 24-26); body weight change (baseline to week 26); and clinically significant or severe hypoglycemia rates (baseline to week 31 [5-week follow-up included]).

RESULTS

At week 26, from baseline values of 8.22% (icodec) and 8.39% (degludec), estimated mean changes in HbA1c were - 1.38% points and - 1.10% points, respectively (estimated treatment difference [95% confidence interval], - 0.28%-points [- 0.50%-points, - 0.05%-points]; p = 0.0152). For icodec and degludec, estimated mean FPG change (- 2.3 mmol/L vs. - 2.3 mmol/L), estimated mean insulin doses (158 U/week vs. 142 U/week), and estimated body weight change (2.5 kg vs. 2.4 kg) were similar. Combined clinically significant or severe hypoglycemia rates were low (0.10 [icodec] vs. 0.07 [degludec] events per patient-year of exposure), with no statistically significant difference between groups.

CONCLUSION

In insulin-naive Chinese individuals with T2D, once-weekly icodec treatment showed significantly greater HbA1c reductions after 26 weeks than once-daily degludec, with low combined clinically significant or severe hypoglycemia rates across groups.

CLINICALTRIALS

GOV IDENTIFIER

NCT04795531.

Hypoglycemia knowledge assessment tool - Development and validation of the Hypoglycemia Management Knowledge Scale in Taiwan

BACKGROUND

Knowledge can guide and support behaviors. With accurate knowledge, patients are better equipped to engage in appropriate self-care behaviors and effectively manage hypoglycemia. However, there is currently a lack of reliable and valid assessment scales specifically designed to measure hypoglycemia knowledge, which could serve as valuable clinical evaluation tools for healthcare professionals.

AIM

To develop and validate a reliable and valid hypoglycemia management knowledge scale to assess the knowledge of hypoglycemia management in patients with diabetes.

METHODS

A cross-sectional study was conducted, recruiting 300 patients with type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan between December 2021 and September 2023.

RESULTS

Initially, 25 questions were selected, achieving a content validity index of 0.92. Through exploratory factor analysis and confirmatory factor analysis, the scale was refined into an 8-factor and 3-factor model, with factor loadings ranging from 0.5 to 0.9. The questions were categorized into three factors: blood glucose determination, carbohydrate supplementation, and blood glucose testing. The internal consistency, measured using the Kuder-Richardson 20 (KR-20), was 0.758.

CONCLUSIONS

The hypoglycemia management knowledge scale developed in this study demonstrated sufficient validity and reliability, making it a useful tool for quickly assessing patients' knowledge of hypoglycemia management and serving as a reference for hypoglycemia education.

Mechanisms mediating effects of cardiotonic steroids in mammalian blood cells

Cardiotonic steroids (CTSs) were known as steroidal plant compounds that exert cellular effects by the binding to Na,K-ATPase. Earlier, plant (exogenous) CTSs were used to treat chronic heart failure. By now, endogenous CTS have been identified in mammals, and their concentrations in the blood, normally in a subnanomolar range, are altered in numerous pathologies. This indicates their role as endogenous regulators of physiological processes. CTS transport occurs primarily in the blood, yet the CTS effects on blood cells remain poorly understood. This review summarizes the CTS effects on blood cells of animals and humans under normal and pathological conditions, and analyzes their action based on known mechanisms of action in mammalian cells. At high concentrations (greater than 10-9 M), CTS binding to Na,K-ATPase inhibits the enzyme, whereas lower concentrations of CTSs induce signaling cascades or activate the enzyme. All these mechanisms are shown to be present in blood cells. The particular CTS effect is determined by the CTS type, its concentration, the isoform composition of the catalytic α-subunit of Na,K-ATPase in the cell, and other cell features. It has been demonstrated that all blood cell types (erythrocytes, leukocytes, and platelets) expressed both ubiquitously distributed α1-isoform and tissue-specific α3-subunit, which exhibits a different ion and CTS affinity compared to α1. This results in a wide spectrum of blood cell responses to fluctuations in CTS levels in the blood. In particular, an increase in the level of endogenous CTSs by a more twofold is sufficient to induce a decline in the activity of erythrocyte Na,K-ATPase. The administration of exogenous CTSs is able to modulate the proinflammatory activity of leukocytes, which is attributed to the activation of signaling cascades, and to exert an influence on platelet activation. Hence, alterations of CTS levels in bloodstream significantly affect the functionality of blood cells, contributing to the organism's adaptive response. On top of this, a comparison of the effects of CTSs on human leukocytes and rodent leukocytes carrying the CTS-resistant α1-isoform often reveals opposite effects, thus indicating that rodents are an unsuitable model for studying CTS effects on these cells.

Cost of hospitalization and length of stay of hypoglycemic events in hospitalized patients with diabetes mellitus: A cross-sectional study

This study aims to assess the length of stay and cost per hypoglycemia episode, as well as to determine the factors that influence the length of stay, intensive care unit (ICU) admission, and hospitalization costs among patients with diabetes mellitus. This is a retrospective cross-sectional study conducted on a cohort of diabetic individuals who experienced confirmed hypoglycemia episodes. The data pertaining to these patients were obtained from their respective hospital medical records, covering the period from January 2021 to December 2022. King Fahd Medical City was selected as the site of data collection for this study. A total of 396 patients were involved in this study. The median duration of stay for the patients was 7.0 (2.0-16.0) days. Only 3.0% of the patients had a previous hypoglycemia admission history. Around 53.3% of the patients were admitted to the ICU. The median duration of ICU admission stay was 1.0 (0.0-1.0) days. The highest cost driver for patients with hypoglycemia was ICU stay with a median cost of 9000.0 (1125.0-15750.0) Saudi Arabia riyal (SAR) (2399.6 (300.0-4199.2) United States dollar (USD)). The total median cost associated with hypoglycemia hospitalization was 4696.0 (886.5-12789.5) SAR (1252.0 (236.4-3410.0) USD). Ex-smokers were more likely to have higher hospitalization costs for hypoglycemia (4.4-folds) (P < .001). Being admitted to the ICU increased the likelihood of having a longer length of hospitalization by 2.6-folds (P < .001). Patients with longer diabetes duration (above 9 years) were more likely to be admitted to the ICU by 2.9-folds (P = .008). Understanding the factors that affect hypoglycemia hospitalization cost and length is essential for improving diabetes care and resource usage. Identifying high-risk patients and implementing efficient preventative strategies can lower the economic burden of DM and accompanying hypoglycemic episodes and enhance DM management.

Hypoglycemia in Hospitalized Patients with Diabetes

Approximately 38% of the patient population in community hospitals throughout the United States has diabetes mellitus. Hypoglycemia is defined as less than 70 mg/dL. Patients with hypoglycemia are at more risk for clinically adverse outcomes including death. Critical care nurses must recognize the signs and symptoms of hypoglycemia and initiate prompt intervention to reduce the risk of mortality.

Timing of Insulin Glargine 300 U/ML: Does It Really Matter in Terms of Efficacy and Safety at Insulin Initiation?

BACKGROUND

The timing of insulin administration, particularly for long-acting insulins like insulin glargine 300 U/mL (Gla-300), plays a critical role in diabetes management. The choice between daytime and nighttime administration of Gla-300 is a nuanced decision that should be tailored to each patient's unique circumstances. This study aims to compare the efficacy and safety profile of insulin initiation with Gla-300 when administered during the day versus at night in adult type 2 diabetes mellitus (T2DM) patients.

METHODS

A retrospective observational study included records of adult T2DM patients initiated on Gla-300 with follow-up data of three months. Cases with complete medical records, including hemoglobin A1C (HbA1C) levels, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), and incidence of hypoglycemic events, were included. Data pertaining to glycaemic control and safety, were extracted and categorized into two groups based on the timing of Gla-300 administration. Records were evaluated over three months and results were statistically analysed.  Results: A total of 169 patients, matched for baseline characteristics, showed a significant reduction in glycaemic indices from initiation to the third month. However, intergroup difference was non-significant suggesting that the timing of administration (morning vs. night) does not significantly impact the effectiveness of Gla-300 in lowering the glycemic indices. Incidences of overall hypoglycemic events were numerically lesser in those with morning dosing of Gla-300 at 13.09% as compared to those with night dosing of Gla-300 at 21.17%. Nocturnal hypoglycaemia was numerically lesser in those with morning dosing of Gla-300 at 3.57% as compared to those with night dosing of Gla-300 at 7.05% observed. However, these intergroup differences were insignificant (p> 0.05).

CONCLUSION

Timing of Gla-300 initiation, morning compared to night dosing, does not significantly impact the effectiveness in lowering the glycemic indices. Incidences of overall and nocturnal hypoglycemic events were numerically lower with morning dosing of Gla-300 compared to night dosing of Gla-300, though it was not statistically significant. An individualized approach to timing and selection of insulin therapy is essential for optimizing glycemic control and minimizing hypoglycemia risk.

SERS profiling of blood serum filtrate components from patients with type II diabetes using 100 kDa filtration devices

Blood carries some of the most valuable biomarkers for disease screening as it interacts with various tissues and organs in the body. Human blood serum is a reservoir of high molecular weight fraction (HMWF) and low molecular weight fraction (LMWF) proteins. The LMWF proteins are considered disease marker proteins and are often suppressed by HMWF proteins during analysis. This issue is addressed by using a filtration device to isolate the filtrate portion from blood serum samples having biomarker proteins up to the size of the cutoff value of the filtration device. In this research, 100 kDa filter devices are employed to obtain the filtrate portions from blood serum samples of type II diabetes mellitus patients and healthy volunteers, followed by characterization using surface-enhanced Raman spectroscopy (SERS) with silver nanoparticles (Ag NPs) as the SERS substrate. By using this approach, the collected filtrate is expected to contain marker proteins at a size of <100 kDa, which are associated with type II diabetes. These marker proteins are in a narrow size range (cutoff value of 100 kDa). Hence, they may be more easily identified by their characteristic SERS spectral features as compared to their analysis in the respective whole blood serum samples due to the exclusion of larger size proteins. These proteins that are present in the filtrate portions of type II diabetes may include adiponectin, C-reactive protein, insulin, leptin, RBP4, IL-6, TNF-α, Fibroblast Growth Factor 21 (FGF21), albumin, transthyretin, alpha-antitrypsin, transferrin, apolipoprotein A-1 (ApoA-1) and fetuin-A. Some prominent SERS bands are observed at 356 cm-1, 435 cm-1, 490 cm-1, 548 cm-1, 596 cm-1, 729 cm-1, 746 cm-1, 950 cm-1, 1330 cm-1, 1362 cm-1, 1573 cm-1 and 1689 cm-1, which differentiate type II diabetes patients from healthy individuals. Moreover, the SERS spectral data sets of various samples are classified using two chemometric approaches: principal component analysis (PCA) and partial least square discriminant analysis (PLS-DA). The validation of the PLS-DA analysis classification model is indicated with 81% accuracy, 79% specificity, and 85% sensitivity, having a value of AUC = 0.75.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early B, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Selvin E, Stanton RC, Bannuru RR. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Home self-management of type 2 diabetes with diabetes technologies in northern France: a focused ethnographic study protocol

INTRODUCTION

Type 2 diabetes is a chronic condition associated with impaired glucose tolerance and a high prevalence of comorbidity, polypharmacy and medication safety incidents. Little is known about the patient work associated with using diabetes management technologies by patients and their informal caregivers at home. This study aims to apply a systems engineering approach to better understand this work.

METHODS AND ANALYSIS

This is a qualitative focused ethnographic study using interview and photography. Adults, living independently at home, with type 2 diabetes who have been using insulin as part of their treatment regimen for a minimum of 6 months and who are using at least one diabetes management technology without support of a professional at home are eligible for inclusion. Participants will be recruited through advertisements on social media, in diabetes clinics and by contacting associations of persons living with diabetes and diabetes specialists. Participant consent will be taken, interviews will be undertaken in the participant's home, audio-recorded and photographs securely saved. The Systems Engineering Initiative for Patient Safety (SEIPS) model will frame the data coding and we will develop new codes to accommodate data outside the SEIPS model. Results will be interpreted to produce a description of work processes, work system elements and interactions that support or jeopardise the achievement of safety. This protocol will follow the consolidated criteria for reporting qualitative research checklist for the reporting of qualitative research interviews.

ETHICAL CONSIDERATIONS AND DISSEMINATION

This protocol was approved by the University of Lille's Behavioural Sciences Ethics Committee. The study will comply with data protection legislation: the protocol has been declared by the Data Protection Officer of the University of Lille to the National Commission on Informatics and Liberty. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and publish in a peer-reviewed journal.

Automated insulin delivery systems in elderly patients with brittle type 2 diabetes

PURPOSE

Geriatric diabetes is complicated by the frailty of this population, and hypoglycemia with insulin is not uncommon in these patients. Automated Insulin Delivery (AID) systems may provide better glycemic control in elderly patients with brittle type 2 diabetes.

METHODS

Thirty-four patients (≥ 60 years) including cancer patients with brittle diabetes were switched to an AID system from multiple-dose insulin (MDI) treatment. HbA1c level, weight, total daily insulin requirement, and C-peptide, creatinine, and lipids were followed for at least six months.

RESULTS

There were 34 patients (14 male, 41.2 %) with a median age of 67 (IQR 63.0-75.5). Six patients (17.6 %) were on chemotherapy and/or steroids (Ch/S). The patients' initial median HbA1c % was 9.3 (IQR 7.6-11.0), c-peptide level was 0.9 (IQR 0.5-2.2) ng/mL, and median total daily insulin dose was 41 IU (IQR 32-53). Six months after the patients were switched to an AID system their HbA1c % decreased to 7.1 (IQR 6.5-8.1), p < 0.001 and c-peptide increased to 1.21 (IQR 0.2-1.7) ng/mL, p = 0.878. Total insulin dose decreased with AID systems [32 IU (IQR 23.9-37.8)), p < 0.001]. There was a decrease in median HbA1c % in patients on Ch/S [8.7 (IQR 7.0-11.5) to 6.9 (IQR 6.3-9.2)] however it didn't reach statistical significance p = 0.225. Total insulin dose also decreased without statistical significance [33 IU (IQR 41-28) to 28 (IQR 23-35), p = 0.173]. The mean time in range (TIR) percent of the patients with AID systems were as follows; <54 mg/dL was 0.5 %, 56-70 mg/dL was 1.3 %, 70-180 mg/dL was 64.8 %, >180 mg/dL was 26.7 % and > 250 mg/dL was 6.7 %.

CONCLUSION

Although AID systems are tested mostly in young type 1 patients our results show that elderly patients with brittle type 2 diabetes also benefit from an AID system. Even in very frail patients such as cancer patients, improvement can be seen.

The association of 24-hour behavior rhythms with stroke among American adults with prediabetes/diabetes: evidence from NHANES 2011-2014

BACKGROUND

Emerging evidence suggests that circadian rhythms play a role in the regulation of cardiovascular diseases (CVDs). We aim to examine the relationship between the 24-hour behavior rhythms (activity-rest and feeding-fasting rhythms) and stroke.

METHODS

The study included 3201 adult participants with prediabetes/diabetes from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. The 24-hour behavior rhythm indices were calculated using data from accelerometer wearable device and dietary recall for two nonconsecutive days. Six indices were calculated including interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), average activity during the least active continuous 5-hour period (L5), Average activity during the most active continuous 10-hour period (M10) which reflects the activity-rest rhythm, and feeding rhythm score which reflects the feeding-fasting rhythm. These continuous variables were divided into quintiles for logistic regression models.

RESULTS

Comparing participants in quintile 1, those in quintile 5 of IS and RA exhibited a lower odds of stroke. Conversely, participants in quintile 5 of IV, L5, and L5 start time demonstrated a higher odds of stroke. Furthermore, participants in quintile 5 of feeding rhythm score had a significantly lower odds of stroke. The associations of IV and feeding rhythm score with stroke were more pronounced in participants with diabetes compared to those with prediabetes/diabetes. No significant associations were observed between other 24-hour behavior rhythms and stroke.

CONCLUSIONS

Overall, this study highlights a significant association between 24-hour behavior rhythm and stroke in American adults with prediabetes/diabetes.

Alzheimer's Disease as Type 3 Diabetes: Understanding the Link and Implications

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) are two prevalent conditions that present considerable public health issue in aging populations worldwide. Recent research has proposed a novel conceptualization of AD as "type 3 diabetes", highlighting the critical roles of insulin resistance and impaired glucose metabolism in the pathogenesis of the disease. This article examines the implications of this association, exploring potential new avenues for treatment and preventive strategies for AD. Key evidence linking diabetes to AD emphasizes critical metabolic processes that contribute to neurodegeneration, including inflammation, oxidative stress, and alterations in insulin signaling pathways. By framing AD within this metabolic context, we can enhance our understanding of its etiology, which in turn may influence early diagnosis, treatment plans, and preventive measures. Understanding AD as a manifestation of diabetes opens up the possibility of employing novel therapeutic strategies that incorporate lifestyle modifications and the use of antidiabetic medications to mitigate cognitive decline. This integrated approach has the potential to improve patient outcomes and deepen our comprehension of the intricate relationship between neurodegenerative diseases and metabolic disorders.

Older Adults Benefit From Virtual Support for Continuous Glucose Monitor Use But Require Longer Visits

BACKGROUND

Older adults may be less comfortable with continuous glucose monitoring (CGM) technology or require additional education to support use. The Virtual Diabetes Specialty Clinic study provided the opportunity to understand glycemic outcomes and support needed for older versus younger adults living with diabetes and using CGM.

METHODS

Prospective, virtual study of adults with type 1 diabetes (T1D, N = 160) or type 2 diabetes (T2D, N = 74) using basal-bolus insulin injections or insulin pump therapy. Remote CGM diabetes education (3 scheduled visits over 1 month) was provided by Certified Diabetes Care and Education Specialists with additional visits as needed. CGM-measured glycemic metrics, HbA1c and visit duration were evaluated by age (<40, 40-64 and ≥65 years).

RESULTS

Median CGM use was ≥95% in all age groups. From baseline to 6 months, time 70 to 180 mg/dL improved from 45% ± 22 to 57% ± 16%; 50 ± 25 to 65 ± 18%; and 60 ± 28 to 69% ± 18% in the <40, 40-64, and ≥65-year groups, respectively (<40 vs 40-64 years P = 0.006). Corresponding values for HbA1c were 8.0% ± 1.6 to 7.3% ± 1.0%; 7.9 ± 1.6 to 7.0 ± 1.0%; and 7.4 ± 1.4 to 7.1% ± 0.9% (all P > 0.05). Visit duration was 41 min longer for ages ≥65 versus <40 years (P = 0.001).

CONCLUSIONS

Adults with diabetes experience glycemic benefit after remote CGM use training, but training time for those >65 years is longer compared with younger adults. Addressing individual training-related needs, including needs that may vary by age, should be considered.

Development and validation of a predictive scoring system for hypoglycaemic agents for optimal control of blood glucose during glucocorticoid therapy

BACKGROUND

Glucocorticoid (GC) treatments are often used. There is limited information on the prediction of hyperglycaemia after GC administration.

AIMS

This study aimed to identify the risk factors for hyperglycaemia after glucocorticoid (GC) administration and the need for hypoglycaemic agents to correct it and to develop and validate a novel scoring system for predicting GC-induced hyperglycaemia.

METHODS

In a development set, 508 adults receiving prednisolone (PSL) for the first time were divided into two groups based on treatment with or without hypoglycaemic agents. Clinical and laboratory parameters were compared, and risk factors were identified using logistic regression analysis after performing univariate analyses between the two groups. A point-addition scoring system with several categories and coefficients for each risk factor was constructed to predict the need for hypoglycaemic agents. The scoring system was then applied and validated on two validation sets: A and B.

RESULTS

Older age, higher glycated haemoglobin percentage, body mass index and initial PSL dosage were identified as risk factors. The sensitivity, specificity and accuracy of the scoring system were 70.6%, 81.9% and 77.1% in the development set; 75.8%, 78.4% and 77.4% in validation set A; and 79.4%, 73.9% and 75.3% in validation set B respectively. By fitting the total score in the development set and the probability of hyperglycaemia to a logistic curve, a figure was created to show the probability of GC-induced hyperglycaemia in patients scheduled to receive GC.

CONCLUSION

This scoring system is a novel, valid and reliable tool for predicting GC-induced hyperglycaemia and the need for hypoglycaemic agents to correct it.

SGLT2 Inhibitor Use and Risk of Dementia and Parkinson Disease Among Patients With Type 2 Diabetes

BACKGROUND AND OBJECTIVES

Despite the mechanistic potential of sodium-glucose cotransporter 2 inhibitor (SGLT2i) to improve neurologic outcomes, the efficacy of SGLT2i in neurodegenerative disorders among patients with type 2 diabetes is not well established. This population-based cohort study aimed to investigate the association of SGLT2i use with risks of incident dementia and Parkinson disease (PD) in patients with type 2 diabetes.

METHODS

This was a retrospective examination of data from a cohort of 1,348,362 participants with type 2 diabetes (≥40 years), who started antidiabetic drugs from 2014 to 2019, evaluated using the Korean National Health Insurance Service Database. Propensity score matching (1:1; SGLT2i to other oral antidiabetic drugs [OADs]) produced a cohort of 358,862 participants. Primary outcomes were the individual incidence of Alzheimer disease (AD), vascular dementia (VaD), and PD. Secondary outcomes were all-cause dementia (AD, VaD, and other dementia) and a composite of all-cause dementia and PD. Cox proportional hazards models were used to investigate the association between SGLT2i use and the risks of dementia and PD.

RESULTS

From the 358,862 participants analyzed (mean [SD] age, 57.8 [9.6] years; 58.0% male), 6,837 incident dementia or PD events occurred. Regarding the individual endpoints, SGLT2i use was associated with reduced risks of AD (adjusted hazard ratio [aHR] 0.81, 95% CI 0.76-0.87), VaD (aHR 0.69, 95% CI 0.60-0.78), and PD (aHR 0.80, 95% CI 0.69-0.91) with a 6-month drug use lag period. In addition, use of SGLT2i was associated with a 21% lower risk of all-cause dementia (aHR 0.79, 95% CI 0.69-0.90) and a 22% lower risk of all-cause dementia and PD than use of other OADs (aHR 0.78, 95% CI 0.73-0.83). The association between the use of SGLT2i and the lowered risk of these neurodegenerative disorders was not affected by sex, Charlson Comorbidity Index, diabetic complications, comorbidities, and medications. Sensitivity analysis further adjusting for bioclinical variables from health screening tests, including blood pressure, glucose, lipid profiles, and kidney function, yielded generally consistent results.

DISCUSSION

In this nationwide population-based study, SGLT2i use significantly reduced the risks of neurodegenerative disorders in patients with type 2 diabetes independent of various factors including comorbidities and bioclinical parameters.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that SGLT2 antidiabetic drugs decrease the risk of dementia and PD in people with diabetes.

Regional disparities in health literacy for chronic diseases: focusing on healthcare resources and local extinction index

Objective

This study compared disparities between community health characteristics and health literacy levels for hypertension and diabetes by combining community-level characteristics, such as the local extinction index and healthcare resources, with individual-level characteristics based on the Andersen healthcare utilization model.

Method

Data obtained from the 2017, 2019, and 2021 Community Health Surveys, Korean Statistical Information Service, and National Health Insurance Service were analyzed. The analyses included spatial analysis, propensity score matching, and cross-analysis.

Results

Twenty-five extinction-risk regions (ERRs) were identified in 2017, 26 in 2019, and 29 in 2021, indicating a high risk of extinction and insufficient healthcare resources in non-metropolitan regions. Based on analyses of demographic changes and unmet medical needs at the individual level, we observed increased age and economic activity, decreased healthcare access, and lower education levels in ERRs compared to non-extinction-risk regions (NERRs). No significant differences were found between the regions regarding diagnosis or medication use concerning the health literacy gap for hypertension and diabetes. However, individuals in ERRs were significantly less likely than those in NERRs to be aware of such diseases or educated about their management.

Discussion

Given that healthcare services in ERRs focus on chronic disease management rather than prevention, we propose two directions to reduce health disparities in ERRs. First, the government should encourage cooperation with private healthcare organizations to ensure the provision of health education programs in vulnerable areas. Second, improvements in awareness and education regarding chronic disease management can be achieved through digital healthcare and telemedicine. This study identifies regional disparities in chronic disease prevention and management, providing a basis for policies to ensure healthier communities with health equity.

An update on the current characteristics and status of care for Muslims with type 2 diabetes fasting during Ramadan: the DAR global survey 2022

BACKGROUND

Managing diabetes during Ramadan fasting is a challenge due lifestyle changes. We described the characteristics and patterns of care for type 2 diabetes mellitus (T2DM) during Ramadan 2020 and 2022.

METHODS

Our study included multinational Muslims with T2DM who were during routine consultation. We collected data on demographics, fasting characteristics, and complications. Descriptive statistics, chi-square test, and multiple testing were performed.

RESULTS

12,529 patients participated. Mean age was 55.2 ± 11.8 years; 52.4% were females. Mean diabetes duration was 9.9 ± 7.4 years; 27.7% were with HbA1c >9% (75 mmol/mol) and 70% had complications. Metformin was the most used medication followed by insulin. 85.1% fasted ≥1 day; fasting mean duration was 27.6 ± 5.6 days. Hypoglycemia occurred in 15.5% of whom 11.7% attended emergency department or were hospitalized; this was significantly associated with age and/or duration of diabetes. Hyperglycemia occurred in 14.9% of whom 6.1% attended emergency department or were hospitalized and was also associated with age or duration of diabetes. 74.2% performed SMBG during fasting. 59.2% were educated on Ramadan fasting, with 89.7% receiving it during routine consultation.

CONCLUSIONS

Ramadan fasting in T2DM is high. Multidisciplinary approach is required to mitigate complications. Our findings support current recommendations for safe fasting.

Society for Ambulatory Anesthesia Updated Consensus Statement on Perioperative Blood Glucose Management in Adult Patients With Diabetes Mellitus Undergoing Ambulatory Surgery

This consensus statement is a comprehensive update of the 2010 Society for Ambulatory Anesthesia (SAMBA) Consensus Statement on perioperative blood glucose management in patients with diabetes mellitus (DM) undergoing ambulatory surgery. Since the original consensus guidelines in 2010, several novel therapeutic interventions have been introduced to treat DM, including new hypoglycemic agents and increasing prevalence of insulin pumps and continuous glucose monitors. The updated recommendations were developed by an expert task force under the provision of SAMBA and are based on a comprehensive review of the literature from 1980 to 2022. The task force included SAMBA members with expertise on this topic and those contributing to the primary literature regarding the management of DM in the perioperative period. The recommendations encompass preoperative evaluation of patients with DM presenting for ambulatory surgery, management of preoperative oral hypoglycemic agents and home insulins, intraoperative testing and treatment modalities, and blood glucose management in the postanesthesia care unit and transition to home after surgery. High-quality evidence pertaining to perioperative blood glucose management in patients with DM undergoing ambulatory surgery remains sparse. Recommendations are therefore based on recent guidelines and available literature, including general glucose management in patients with DM, data from inpatient surgical populations, drug pharmacology, and emerging treatment data. Areas in need of further research are also identified. Importantly, the benefits and risks of interventions and clinical practice information were considered to ensure that the recommendations maintain patient safety and are clinically valid and useful in the ambulatory setting. What Other Guidelines Are Available on This Topic? Since the publication of the SAMBA Consensus Statement for perioperative blood glucose management in the ambulatory setting in 2010, several recent guidelines have been issued by the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the Endocrine Society, the Centre for Perioperative Care (CPOC), and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) on DM care in hospitalized patients; however, none are specific to ambulatory surgery. How Does This Guideline Differ From the Previous Guidelines? Previously posed clinical questions that were outdated were revised to reflect current clinical practice. Additional questions were developed relating to the perioperative management of patients with DM to include the newer therapeutic interventions.

Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus

BACKGROUND

The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate.

OBJECTIVE

To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus.

METHODS

The study was conducted at King Abdullah University Hospital (KAUH) at the outpatient diabetes clinic from October 1st, 2022 to August 1st, 2023. Variables such as socio-demographics, medication history, and comorbidities were obtained using electronic medical records. The prevalence of hypoglycemia was determined through patient interviews during their clinic visit. Patients were prospectively monitored for hospital admissions, emergency department visits, and mortality using electronic medical records over a three-month follow-up period. Logistic regression models were conducted to identify factors associated with hypoglycemia and hospital admissions/ emergency visits. Ethical Approval (Reference # 53/151/2022) was obtained on 19/9/2022.

RESULTS

Electronic medical charts of 640 patients who have type 2 diabetes mellitus and age ≥ 60 years were evaluated. The mean age ± SD was 67.19 (± 5.69) years. Hypoglycemia incidents with different severity levels were prevalent in 21.7% (n = 139) of the patients. Insulin administration was significantly associated with more hypoglycemic events compared to other antidiabetic medication. Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases. Patients with dyslipidemia also had a higher risk of hypoglycemia (odd ratio = 1.87). Regression analysis revealed that hypoglycemia and educational level were significant predictors for hospital admission and emergency department (ER) visits. Hypoglycemia was a positive predictor, meaning it increased the odds of these outcomes, while having a college degree or higher was associated with reduced odds of hospital admission and ER visits.

CONCLUSION

Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population.

Validity of an ICD-10 Coding Algorithm for Acute Heat Illness in the Emergency Department: A Retrospective Cohort Study

Acute heat illness (AHI) from extreme environmental heat exposure can lead to emergency department (ED) visits, hospitalization, and even death. While the ICD ninth revision codes for AHI have been validated in the U.S., there have been no studies on the validity of ICD-10 codes for AHI in Canada. The objective of this study was to assess the validity of an ICD-10 coding algorithm for ED encounters for AHI. We conducted a retrospective cohort study of children and adults who had ED encounters at two large academic, tertiary hospitals in London, Canada, between May and September 2014-2018. We developed an algorithm of ICD-10 codes for AHI based upon a literature review and clinical expertise. Our "gold-standard" definition of AHI was patient-reported heat exposure and documentation of at least one heat-related complaint. To establish positive predictive value (PPV), we reviewed 62 algorithm-positive records and noted which met our "gold-standard" definition. To calculate negative predictive value (NPV), sensitivity (Sn), and specificity (Sp), we randomly reviewed 964 ED records for associated ICD-10 codes and diagnoses. Two independent reviewers completed blinded data abstraction, with duplicate abstraction in 20% of the sample. Of the 62 algorithm-positive records, mean (SD) age was 38.8 (23.8) years; 37% were female. PPV was 61.3 ± 12.1% (95% CI). Of the 964 randomly selected records, mean (SD) age was 41.7 (26.5) years; 51.1% were female. The NPV was 99.7 ± 0.4%, sensitivity 25.0 ± 42.4%, and specificity 100.0 ± 0.0%. An ICD-10 coding algorithm for AHI had high specificity but was limited in sensitivity. This algorithm can be used to assemble and study cohorts of patients who have had an AHI, but may underestimate the true incidence of AHI presentations in the ED.

Hypoglycemia in Terminally Ill Patients with Cancer with a History of Diabetes Mellitus Admitted to a General Ward: A Retrospective Observational Study

Background

Poor glycemic control may be a risk factor for hypoglycemia in terminally ill patients with cancer with a history of diabetes mellitus (DM). However, no guidelines have been established for achieving glycemic control in this patient population, and epidemiological information remains lacking.

Objectives

We aimed to investigate the prevalence of hypoglycemic episodes and provide epidemiological information on hypoglycemia in terminally ill patients with cancer with a history of DM admitted to a general ward.

Design

This was a single-center, retrospective, observational study.

Setting/Subjects

This study enrolled terminally ill patients with cancer with a history of DM, receiving palliative care at a hospital in Japan between January 2017 and July 2022.

Measurements

Data extracted from the patients' medical records were age, sex, body mass index, primary cancer, liver metastases, dialysis status, Eastern Cooperative Oncology Group performance status score, type and duration of DM, HbA1c level, and use of diabetes medications (antihyperglycemic agents and types and insulin) at the time of initial visit within 180 days of death.

Results

Among the 104 patients included in the analysis, hypoglycemic episodes occurred in 36 patients (34.6%). The total number of hypoglycemic episodes was 132, and the median number of hypoglycemic episodes for each patient during hospitalization was 2.5 (interquartile range, 1-6).

Conclusions

The prevalence of hypoglycemia in terminally ill patients with cancer with a history of DM who were admitted to a Japanese general ward was 34.6%. Further studies are needed to determine the frequency of hypoglycemia because of overtreatment in this patient population.

Risk factors and prediction of hypoglycaemia using the Hypo-RESOLVE cohort: a secondary analysis of pooled data from insulin clinical trials

AIMS/HYPOTHESIS

The objective of the Hypoglycaemia REdefining SOLutions for better liVES (Hypo-RESOLVE) project is to use a dataset of pooled clinical trials across pharmaceutical and device companies in people with type 1 or type 2 diabetes to examine factors associated with incident hypoglycaemia events and to quantify the prediction of these events.

METHODS

Data from 90 trials with 46,254 participants were pooled. Analyses were done for type 1 and type 2 diabetes separately. Poisson mixed models, adjusted for age, sex, diabetes duration and trial identifier were fitted to assess the association of clinical variables with hypoglycaemia event counts. Tree-based gradient-boosting algorithms (XGBoost) were fitted using training data and their predictive performance in terms of area under the receiver operating characteristic curve (AUC) evaluated on test data. Baseline models including age, sex and diabetes duration were compared with models that further included a score of hypoglycaemia in the first 6 weeks from study entry, and full models that included further clinical variables. The relative predictive importance of each covariate was assessed using XGBoost's importance procedure. Prediction across the entire trial duration for each trial (mean of 34.8 weeks for type 1 diabetes and 25.3 weeks for type 2 diabetes) was assessed.

RESULTS

For both type 1 and type 2 diabetes, variables associated with more frequent hypoglycaemia included female sex, white ethnicity, longer diabetes duration, treatment with human as opposed to analogue-only insulin, higher glucose variability, higher score for hypoglycaemia across the 6 week baseline period, lower BP, lower lipid levels and treatment with psychoactive drugs. Prediction of any hypoglycaemia event of any severity was greater than prediction of hypoglycaemia requiring assistance (level 3 hypoglycaemia), for which events were sparser. For prediction of level 1 or worse hypoglycaemia during the whole follow-up period, the AUC was 0.835 (95% CI 0.826, 0.844) in type 1 diabetes and 0.840 (95% CI 0.831, 0.848) in type 2 diabetes. For level 3 hypoglycaemia, the AUC was lower at 0.689 (95% CI 0.667, 0.712) for type 1 diabetes and 0.705 (95% CI 0.662, 0.748) for type 2 diabetes. Compared with the baseline models, almost all the improvement in prediction could be captured by the individual's hypoglycaemia history, glucose variability and blood glucose over a 6 week baseline period.

CONCLUSIONS/INTERPRETATION

Although hypoglycaemia rates show large variation according to sociodemographic and clinical characteristics and treatment history, looking at a 6 week period of hypoglycaemia events and glucose measurements predicts future hypoglycaemia risk.

Drug-induced hypoglycemia: a disproportionality analysis of the FAERS database

BACKGROUND

Hypoglycemia is an adverse event (AE) that cannot be ignored in clinical practice. This study aimed to identify the most common and top drugs associated with the risk of hypoglycemia based on the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database.

RESEARCH DESIGN AND METHODS

We used OpenVigil 2.1 pharmacovigilance analytics platform to query FAERS database and data from 2004 to 2023 were retrieved. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify hypoglycemia cases, and DrugBank database was used to determine drug generic names.

RESULTS

A total of 11,155,106 AEs reports were identified, of which 28,443 (0.25%) were related to hypoglycemia. Metformin (6926 cases) was associated with most cases of hypoglycemia. According to the disproportionality analysis, the top five drugs with the highest ROR and PRR were penamecillin, nikethamide, sotagliflozin, norethandrolone, glimepiride/pioglitazone. Nineteen of the top 50 drugs did not have hypoglycemia indicated in the package insert.

CONCLUSIONS

By analyzing the FAERS database, we listed drugs with a strong hypoglycemic signal for which the label does not provide a reminder. Notably, the potential hypoglycemia risks are of great importance and should be closely monitored in medical practice.

Maternal hypothyroidism and subsequent metabolic outcomes in children: a systematic review and meta-analysis

INTRODUCTION

As the fetus relies on maternal thyroid hormones in early pregnancy, maternal hypothyroidism plays an important role in fetal development. However, the association between maternal hypothyroidism and metabolic disease in offspring is unclear.

OBJECTIVE

To examine the association between maternal hypothyroidism in pregnancy and metabolic outcomes (obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia) in children < 18 years.

METHODS

We systematically searched 5 databases from inception to May 2023. Eligible studies included cohort, case-control, and randomized controlled trials involving children born to mothers with or without hypothyroidism in pregnancy. Data were pooled across studies using random-effects models for outcomes reported in at least three studies. Quality assessment was performed using the ROBINS-E tool for observational studies and the Cochrane Risk of Bias tool for trials.

RESULTS

The search identified 3221 articles, of which 7 studies were included (1 trial, 6 observational). All studies were conducted outside of North America and ranged in size from 250 to > 1 million children. The follow-up time ranged from 6 to 20 years. Included studies support an increased risk of hypertension and glucose dysregulation in offspring exposed to maternal hypothyroidism (hypertension: OR 1.08, 95% CI 0.75, 1.57 and HR 1.81, 95% CI 1.21, 2.69; diabetes: RR 2.7, 95% CI 0.7, 10). In the pooled analysis, maternal hypothyroidism was not associated with obesity in offspring (OR 1.04, 95% CI 0.64, 1.70).

CONCLUSION

This study found inconsistent evidence on the association between maternal hypothyroidism in pregnancy and metabolic outcomes in offspring, though associations with hypertension and glucose dysregulation are possible.

Impacts of medication adherence and home healthcare on the associations between polypharmacy and the risk of severe hypoglycemia among elderly diabetic patients in Taiwan from 2002 to 2012: A nationwide case-crossover study

AIM

To assess how medication adherence and home healthcare support influence the role of polypharmacy in induced hypoglycemia events among elderly diabetic patients.

METHODS

This case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1-3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis.

RESULTS

Totally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16-1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24-1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia.

CONCLUSIONS

Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy.

Generalization of a Deep Learning Model for Continuous Glucose Monitoring-Based Hypoglycemia Prediction: Algorithm Development and Validation Study

Background

Predicting hypoglycemia while maintaining a low false alarm rate is a challenge for the wide adoption of continuous glucose monitoring (CGM) devices in diabetes management. One small study suggested that a deep learning model based on the long short-term memory (LSTM) network had better performance in hypoglycemia prediction than traditional machine learning algorithms in European patients with type 1 diabetes. However, given that many well-recognized deep learning models perform poorly outside the training setting, it remains unclear whether the LSTM model could be generalized to different populations or patients with other diabetes subtypes.

Objective

The aim of this study was to validate LSTM hypoglycemia prediction models in more diverse populations and across a wide spectrum of patients with different subtypes of diabetes.

Methods

We assembled two large data sets of patients with type 1 and type 2 diabetes. The primary data set including CGM data from 192 Chinese patients with diabetes was used to develop the LSTM, support vector machine (SVM), and random forest (RF) models for hypoglycemia prediction with a prediction horizon of 30 minutes. Hypoglycemia was categorized into mild (glucose=54-70 mg/dL) and severe (glucose<54 mg/dL) levels. The validation data set of 427 patients of European-American ancestry in the United States was used to validate the models and examine their generalizations. The predictive performance of the models was evaluated according to the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

Results

For the difficult-to-predict mild hypoglycemia events, the LSTM model consistently achieved AUC values greater than 97% in the primary data set, with a less than 3% AUC reduction in the validation data set, indicating that the model was robust and generalizable across populations. AUC values above 93% were also achieved when the LSTM model was applied to both type 1 and type 2 diabetes in the validation data set, further strengthening the generalizability of the model. Under different satisfactory levels of sensitivity for mild and severe hypoglycemia prediction, the LSTM model achieved higher specificity than the SVM and RF models, thereby reducing false alarms.

Conclusions

Our results demonstrate that the LSTM model is robust for hypoglycemia prediction and is generalizable across populations or diabetes subtypes. Given its additional advantage of false-alarm reduction, the LSTM model is a strong candidate to be widely implemented in future CGM devices for hypoglycemia prediction.

Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings

BACKGROUND

Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes.

METHODS

Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated.

RESULTS

Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj β coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj βcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj βcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj βcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj βcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj βcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036).

CONCLUSION

A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.

Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement

Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.

Preventing severe hypoglycemia in adults with type 2 diabetes (PHT2): Design, delivery and evaluation framework for a randomized controlled trial

BACKGROUND

Severe hypoglycemia is a common and feared complication of medications used to lower blood glucose levels in individuals with diabetes. Psychoeducational interventions can prevent severe hypoglycemia in individuals with type 1 diabetes (T1D). We aim to determine the effectiveness of this approach among adults with type 2 diabetes (T2D) at elevated risk for severe hypoglycemia.

METHODS

Preventing Hypoglycemia in Type 2 diabetes (PHT2) is a two-arm, parallel, randomized controlled trial. Participants are eligible if they are adults with T2D receiving care at an integrated group practice in Washington state and have experienced one or more episodes of severe hypoglycemia in the prior 12 months or have impaired awareness of hypoglycemia (Gold score ≥ 4). Participants are randomized to proactive nurse care management with or without my hypo compass, an evidence-based, psychoeducational intervention combining group and individual self-management training. For this study, my hypo compass was adapted to be suitable for adults with T2D and from an in-person to a virtual intervention over videoconference and telephone. The primary outcome is any self-reported severe hypoglycemia in the 12 months following the start of the intervention. Secondary outcomes include biochemical measures of hypoglycemia, self-reported hypoglycemia awareness, fear of hypoglycemia, and emergency department visits and hospitalizations for severe hypoglycemia. The study includes a process evaluation to assess implementation fidelity and clarify the causal pathway.

CONCLUSION

The PHT2 trial will compare the effectiveness of two approaches for reducing severe hypoglycemia in adults with T2D.

TRIAL REGISTRATION

clinicaltrials.gov, # NCT04863872.

Development and validation of a prediction model for self-reported hypoglycemia risk in patients with type 2 diabetes: A longitudinal cohort study

AIMS/INTRODUCTION

To develop and validate a simple prediction model for hypoglycemia risk in patients with type 2 diabetes.

MATERIALS AND METHODS

We prospectively analyzed the data of 1,303 subjects in a third-class hospital in Tianjin and followed up their hypoglycemia events at 3 and 6 months. The hypoglycemia risk prediction models for 3 and 6 months were developed and the model performance was evaluated.

RESULTS

A total of 340 (28.4%) patients experienced hypoglycemia within 3 months and 462 (37.2%) within 6 months during the follow-up period. Age, central obesity, intensive insulin therapy, frequency of hypoglycemia in the past year, and hypoglycemia prevention education entered both model3month and model6month. The area under the receiver operating characteristic curve of model3month and model6month were 0.711 and 0.723, respectively. The Youden index was 0.315 and 0.361, while the sensitivities were 0.615 and 0.714, and the specificities were 0.717 and 0.631. The calibration curves showed that the models were similar to reality. The decision curves implied that the clinical net benefit of the model was clear.

CONCLUSIONS

The study developed 3 and 6 month hypoglycemia risk prediction models for patients with type 2 diabetes. The discrimination and calibration of the two prediction models were good, and might help to improve clinical decision-making and guide patients to more reasonable self-care and hypoglycemia prevention at home.

A novel electronic health record-based, machine-learning model to predict severe hypoglycemia leading to hospitalizations in older adults with diabetes: A territory-wide cohort and modeling study

BACKGROUND

Older adults with diabetes are at high risk of severe hypoglycemia (SH). Many machine-learning (ML) models predict short-term hypoglycemia are not specific for older adults and show poor precision-recall. We aimed to develop a multidimensional, electronic health record (EHR)-based ML model to predict one-year risk of SH requiring hospitalization in older adults with diabetes.

METHODS AND FINDINGS

We adopted a case-control design for a retrospective territory-wide cohort of 1,456,618 records from 364,863 unique older adults (age ≥65 years) with diabetes and at least 1 Hong Kong Hospital Authority attendance from 2013 to 2018. We used 258 predictors including demographics, admissions, diagnoses, medications, and routine laboratory tests in a one-year period to predict SH events requiring hospitalization in the following 12 months. The cohort was randomly split into training, testing, and internal validation sets in a 7:2:1 ratio. Six ML algorithms were evaluated including logistic-regression, random forest, gradient boost machine, deep neural network (DNN), XGBoost, and Rulefit. We tested our model in a temporal validation cohort in the Hong Kong Diabetes Register with predictors defined in 2018 and outcome events defined in 2019. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC) statistics, and positive predictive value (PPV). We identified 11,128 SH events requiring hospitalization during the observation periods. The XGBoost model yielded the best performance (AUROC = 0.978 [95% CI 0.972 to 0.984]; AUPRC = 0.670 [95% CI 0.652 to 0.688]; PPV = 0.721 [95% CI 0.703 to 0.739]). This was superior to an 11-variable conventional logistic-regression model comprised of age, sex, history of SH, hypertension, blood glucose, kidney function measurements, and use of oral glucose-lowering drugs (GLDs) (AUROC = 0.906; AUPRC = 0.085; PPV = 0.468). Top impactful predictors included non-use of lipid-regulating drugs, in-patient admission, urgent emergency triage, insulin use, and history of SH. External validation in the HKDR cohort yielded AUROC of 0.856 [95% CI 0.838 to 0.873]. Main limitations of this study included limited transportability of the model and lack of geographically independent validation.

CONCLUSIONS

Our novel-ML model demonstrated good discrimination and high precision in predicting one-year risk of SH requiring hospitalization. This may be integrated into EHR decision support systems for preemptive intervention in older adults at highest risk.

Exploring determinants of sex and family history-based disparity in type 2 diabetes mellitus prevalence among clinical patients

BACKGROUND

Type 2 diabetes mellitus represents a multifaceted disorder characterized by intricate pathophysiological mechanisms, encompassing diminished insulin secretion, augmented hepatic glucose production, and heightened insulin resistance. This study aims to assess the sex (Male and Female only) and family history-based differences in the prevalence of T2DM and explore the determinants contributing to this disparity among clinical patients.

SUBJECTS AND METHODS

The study encompassed a diverse pool of clinical patients, encompassing both individuals with diabetes and those without the condition, who had previously sought medical attention for clinical checkups at healthcare centers. The collected data included essential parameters such as blood pressure, weight, height, smoking habits, educational background, and physical activity levels. To ensure methodological rigor and data accuracy, blood pressure measurements adhered to the stringent guidelines set forth by the World Health Organization.

RESULTS

Participants of the present study reported diabetes, among which notable findings emerged regarding health indicators. It was observed that the prevalence of high blood pressure, obesity, and high blood cholesterol exhibited a statistically significant increase among the female participants, underscoring the sex-based disparities in these health parameters. The male population aged 60 or older, the presence of a family history of DM accentuated this risk, resulting in a striking 3.1 times higher prevalence compared to females, who exhibited a 2.4 times higher risk (OR = 2.4, p = 0.0008). This intriguing relationship between diabetes and cholesterol levels was not limited to sex. Both male (OR = 2.47) and female (OR = 2.1) diabetes patients displayed highly significant associations with cholesterol levels. The risk of T2DM was significantly associated with triglycerides in both sexes (1.58 times higher in males, and 1.71 times higher in females).

CONCLUSIONS

The significance of hypertension as a comorbidity in T2DM, highlighting sex-specific associations and the potential impact of a family history of diabetes on blood pressure. Our findings emphasize the importance of considering lipid profiles, obesity, and their sex-specific associations when assessing and managing diabetes risk. Comprehensive diabetes care should include strategies for lipid control, weight management, and cardiovascular risk reduction, tailored to the individual's sex and specific risk profile.

Effect of fear of hypoglycaemia on sleep quality of patients with type 2 mellitus diabetes: The mediating role of alexithymia

Background

Patients with type 2 diabetes mellitus (T2DM) commonly experience poor sleep quality. This study aimed to investigate whether alexithymia mediates the association between fear of hypoglycaemia (FoH) and sleep quality in patients with T2DM.

Methods

From September 2021 to November 2021, a cross-sectional survey was conducted on 407 patients with T2DM in China. Data collection was made possible through the administration of the Chinese Version of the Worry Scale, Toronto Alexithymia Scale and Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Multiple linear regression analyses were also performed.

Results

A total of 65.6% of the participants were male, and 75.7% were aged 18-40 years. FoH showed a moderate and positive correlation with CPSQI scores (r = 0.308, p < 0.001). Alexithymia was weakly and positively correlated with CPSQI scores (r = 0.185, p < 0.001). Meanwhile, FoH exhibited a moderate and positive correlation with alexithymia (r = 0.422, p < 0.001), and difficulty in identifying (r = 0.414, p < 0.001) and describing feelings (r = 0.416, p < 0.001) and a weak and positive correlation with externally oriented thinking (r = 0.221, p < 0.001). The total effect (β = 0.408, p < 0.001) of FoH on CPSQI comprised not only the direct (β = 0.293, 95% confidence interval: 0.174-0.411, p < 0.001) but also the indirect effect (β = 0.115, p < 0.001) of alexithymia.

Conclusions

Alexithymia can mediate the association between FoH and sleep quality. Clinicians should recognize the potential effect of alexithymia and incorporate it in intervention planning and care. Addressing the affective disturbances arising from FoH can enhance emotional expression and sleep quality among T2DM patients.

Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review

In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.

Association of hypoglycemic events with cognitive impairment in patients with type 2 diabetes mellitus: Protocol for a dose-response meta-analysis

INTRODUCTION

With an incidence rate as high as 46%-58%, hypoglycemia is a common complication of glycemic management among those suffering from type 2 diabetes mellitus(T2DM). According to preclinical research, hypoglycemia episodes may impair cognition by harming neurons. However, there is still controversy regarding the clinical evidence for the relationship between hypoglycemic events and the likelihood of cognitive impairment. Furthermore, little research has been done on the dose-response association between hypoglycemia incidents and the possibility of cognitive impairment. To address these knowledge gaps, the present research intends to update the comprehension of the association among hypoglycemic events and the risk of cognitive impairment and to clarify the correlation between dose and response by incorporating the most recent investigations.

METHOD AND ANALYSIS

This work has developed a protocol for a systematic review and meta-analysis that will examine, via a well-organized assessment of several databases, the relationship between the incidence of hypoglycemia and the probability of cognitive impairment. Observational studies investigating the connection between hypoglycemia episodes and cognitive impairment will be included. The databases that will be searched are PubMed, Web of Science, the Chinese Biomedical Literature Database (CBM), Cochrane Library, Embase, the China National Knowledge (CNKI), Wan Fang, the Chinese Science and Technology Periodical Database (VIP), and Du Xiu. Literature from the establishment of each database to December 2023 will be included in the search. Two researchers will independently screen the studies that satisfy the requirements for both inclusion and exclusion. A third researcher will be asked to mediate any disputes. The methodological caliber of the studies included will be assessed utilizing the Newcastle-Ottawa Scale (NOS) or the Joanna Briggs Institute (JBI) critical appraisal method. With regard to GRADE, which stands for Grading of Recommendations, Assessment, Development, and Evaluation, the quality of the evidence will be evaluated. ROBIS Tool will be used to evaluate the risk of bias in the development of the systematic review. If the data is accessible, meta-analysis and dose-response curve analysis will be employed by Stata software. However, if the data does not allow for such analysis, a descriptive review will be performed.

DISCUSSION AND CONCLUSION

Hypoglycemic episodes may raise the likelihood of cognitive impairment, according to earlier investigations. This study will update the relevant evidence and explore the dose-response connection between hypoglycemic episodes and cognitive impairment. The results of this review will have significant effects on decision-making by individuals with diabetes, healthcare providers, and government policy institutions.

TRIAL REGISTRATION

Prospero registration number: CRD42023432352.

Barriers and solutions for the management of severe hypoglycaemia in people with diabetes in Spain: A Delphi survey

BACKGROUND AND OBJECTIVE

Severe hypoglycaemia (SH) imposes a significant burden for people with diabetes (PwD), their caregivers (CGs), and the healthcare system. The study aimed to identify barriers and solutions in the management of SH in PwD in Spain, gathering consensus from physicians and nurses.

MATERIAL AND METHODS

Expert opinion from physicians and nurses who manage PwD was collected via a 2-round online Delphi method. Consensus was predefined as ≥ 70% of the panellists agreeing or disagreeing with the statement.

RESULTS

Physicians (n = 25) and nurses (n = 17) reached ≥ 90% consensus on the following barriers for the management of SH: absence of symptoms, cost to the health system, lack of implementation of glucose monitoring devices, lack of patient training to identify and manage SH, and the fear of SH in children and CGs. Main solutions, identified with ≥ 70% consensus, included training, education, and psychological support using diabetes nurse educators and the use of new glucose monitoring technologies and applications.

CONCLUSIONS

This study provides valuable insights on the barriers and solutions in the management of SH in Spain. Structured self-management training, the support of diabetes educators, and the use of insulin delivery devices and glucose monitoring technologies is required for the management of SH.

A novel hypoglycemia alarm framework for type 2 diabetes with high glycemic variability

In patients with type 2 diabetes (T2D), accurate prediction of hypoglycemic events is crucial for maintaining glycemic control and reducing their frequency. However, individuals with high blood glucose variability experience significant fluctuations over time, posing a challenge for early warning models that rely on static features. This article proposes a novel hypoglycemia early alarm framework based on dynamic feature selection. The framework incorporates domain knowledge and introduces multi-scale blood glucose features, including predicted values, essential for early warnings. To address the complexity of the feature matrix, a dynamic feature selection mechanism (Relief-SVM-RFE) is designed to effectively eliminate redundancy. Furthermore, the framework employs online updates for the random forest model, enhancing the learning of more relevant features. The effectiveness of the framework was evaluated using a clinical dataset. For T2D patients with a high coefficient of variation (CV), the framework achieved a sensitivity of 81.15% and specificity of 98.14%, accurately predicting most hypoglycemic events. Notably, the proposed method outperformed other existing approaches. These results indicate the feasibility of anticipating hypoglycemic events in T2D patients with high CV using this innovative framework.

Medication-Related Hospital Admissions and Emergency Department Visits in Older People with Diabetes: A Systematic Review

Limited data are available regarding adverse drug reactions (ADRs) and medication-related hospitalisations or emergency department (ED) visits in older adults with diabetes, especially since the emergence of newer antidiabetic agents. This systematic review aimed to explore the nature of hospital admissions and ED visits that are medication-related in older adults with diabetes. The review was conducted according to the PRISMA guidelines. Studies in English that reported on older adults (mean age ≥ 60 years) with diabetes admitted to the hospital or presenting to ED due to medication-related problems and published between January 2000 and October 2023 were identified using Medline, Embase, and International Pharmaceutical Abstracts databases. Thirty-five studies were included. Medication-related hospital admissions and ED visits were all reported as episodes of hypoglycaemia and were most frequently associated with insulins and sulfonylureas. The studies indicated a decline in hypoglycaemia-related hospitalisations or ED presentations in older adults with diabetes since 2015. However, the associated medications remain the same. This finding suggests that older patients on insulin or secretagogue agents should be closely monitored to prevent potential adverse events, and newer agents should be used whenever clinically appropriate.

[Determination of the goals of therapeutic control of type 2 diabetes mellitus in elderly patients using a digital clinical calculator.]

According to the federal register, up to 3,77 million elderly Russians have a confirmed diagnosis of type 2 diabetes mellitus (DM2), the most important criterion for the effectiveness of treatment of which is the achievement of therapeutic control targets. At the same time, the structure of the algorithm for their assessment in elderly patients is quite complex and involves the analysis of many different parameters, including indicators of geriatric status. The aim of the study was to develop a digital clinical calculator for determining individual goals of DM2 control in elderly patients based on the principles of evidence-based medicine. The methodology of their assessment is based on the clinical recommendations of the Ministry of Health of the Russian Federation on DM2 and senile asthenia, as well as taking into account the IDF guidelines. Priority attention is given to the assessment of glycemic control indicators. The Calculator matrix allows you to determine 5 response variables: the target range of HbA1c, target LDL and blood pressure levels, the number of risk factors for ASD and the category of functional dependence of an elderly person. The last parameter can be calculated automatically based on the results of processing information entered into the corresponding modules of the Calculator: the questionnaire block «Age is not a hindrance»; an original algorithm for screening for probable sarcopenia according to objective clinical criteria; windows for entering scores on the Bartel, Lawton and Mini-Cog scales. An analysis of the features of the therapeutic management of elderly patients with DM2 and clinical experience in the application of the Calculator led to the conclusion that it is necessary to limit the lower limit of the target range of HbA1c values for people over the age of 60 years, with an emphasis on a digital methodology for weighted risk assessment and the potential benefits of intensifying treatment of DM2, taking into account geriatric status; the results are stored in digital format, which allows you to use They are used for CGO and monitoring the effectiveness of the treatment.

American Diabetes Association Professional Practice Committee, ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Selvin E, Stanton RC, Gabbay RA. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.