Frequency and Predictors of Level 2 Time Above Range (TAR) in Older Adults with Type 2 Diabetes on Insulin Therapy-Data from the HYPOAGE Prospective Study

Background: Although type 2 diabetes (T2D) is very common in older patients, there is a lack of real-life data on blood glucose control in this specific population. We aimed to determine the frequency and predictors of hyperglycemia in older patients with T2D on insulin therapy by using continuous glucose monitoring (CGM). Methods: HYPOAGE is prospective multicenter study including 146 insulin-treated older adults aged 75 and older, with T2D for at least 1 year and treated with insulin for at least 6 months. All patients benefited from ambulatory blinded CGM for 28 consecutive days with FreeStyle Libre Pro® sensor. All participants underwent a geriatric and diabetic assessment. Multivariable logistic regressions were used to identify factors associated with level 2 time above range (TAR)[glucose concentration >13.9 mmol/L] > 10%. Results: The mean age of the 141 analyzed patients was 81.5±5.3 years and 56.7% were male, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy after geriatric assessment. The mean baseline HbA1c was 7.9±1.0% and 43 patients (30%) had TAR (level 2) > 10%. Compared to patients with level 2 TAR ≤ 10%, patients with higher TAR were older (83.5 [5.7] vs 80.6 [4.9] years), with lower BMI (28.0 [5.5] vs 31.3 [6.1] kg/m2), higher HbA1c (8.6 [0.9] vs 7.6 [0.9] %), and a less frequent healthy geriatric status (14.0 vs 33.7%). In multivariate analyses, TAR (level 2) > 10% remains only significantly associated with HbA1c (OR: 3.08 for 1% increase [1.72-5.50], p=0.0002) and BMI (OR: 0.92 [0.84-1.00], p=0.0496). Conversely, HbA1c was not significantly associated with hypoglycemia (i.e. level 2 time below range [glucose concentration < 3.0 mmol/L]). Conclusions: In this real-life study, 30% of older patients are above the TAR target recommended by the ATTD 2019 consensus (< 10% for level 2) HbA1C is a better predictor of time spent in hyperglycemia than of hypoglycemia in older patients on insulin therapy. Disclosure B.Cariou: Board Member; Eli Lilly and Company, Novartis, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca, Novo Nordisk, Sanofi. S.Hadjadj: Consultant; Bayer Inc., Novo Nordisk, Valbiotis, Research Support; AstraZeneca, Novartis, Speaker's Bureau; Abbott Diagnostics, Boehringer-Ingelheim. A.Boureau: Board Member; Pfizer Inc. Hypoage study group: n/a. Funding Sanofi