Diabetes treatment and hypoglycaemic episodes in elderly patients at nursing homes in Uppsala County

Figures & data

Figure 1. Design of the recruitment of patients.

Figure 2. The correlation between HbA_1c (mmol/mol) and diabetes duration (years); P = 0.006.

Table 1. Clinical characteristics of 218 diabetes patients at 30 nursing homes, and type of diabetes treatment. Patients were divided into three groups by their different HbA_1c levels.

Groups	All	HbA1c <52	HbA1c 52–73	HbA1c >73	No HbA1c
Number of patients	218	94	78	28	18
Gender (female/male)	137/81	59/35	50/28	17/11	11/7
Age (years)	84.6 ± 8.0	84.1 ± 7.8	84.3 ± 9.0	85.0 ± 7.4
BMI (kg/m^2)	26.3 ± 5.7	26.8 ± 5.8	26.8 ± 6.0	25.2 ± 5.1
Duration (years)	11.2 ± 9.4	8.6 ± 6.4	13.0 ± 11.0	16.8 ± 10.7
HbA1c (mmol/mol)	56.0 ± 1.2	44.0 ± 1.1	60.0 ± 1.1	86.0 ± 1.2
Creatinine	53.9 ± 6.9	57.0 ± 28.7	54.4 ± 25.9	52.3 ± 27.0
Diabetes treatment:
Unknown	6	3	2	1
Dietary (n)	82	57^a	12	2	11
OADs (n)	61	25	27	5	4
Insulin (n)	44	4^a	25	12	3
OADs + insulin (n)	25	5^a	12	8	0

Data shown are arithmetic means (±SD).

^a Statistically significant difference (P < 0.05) between groups HbA_1c <52 and HbA_1c ≥52 mmol/mol.

BMI: body mass index; OADs: oral antidiabetic drugs.

Table 2. Patients treated with insulin as single therapy or in combination with oral antidiabetic drugs. Daily doses expressed in international units. The patients were divided into three groups by different HbA_1c levels.

Groups	All	HbA1c <52	HbA1c 52–73	HbA1c >73
Number of patients (daily doses, IU):
Insulin	69 (31 ± 21)	9 (33 ± 21)	37 (26 ± 19)	20 (35 ± 21)
Long-acting	14 (28 ± 18)	2 (37 ± 35)	7 (28 ± 21)	5 (24 ± 5)
Intermediate-acting	26 (20 ± 12)	3 (23 ± 11)	15 (16 ± 11)	6 (24 ± 13)
Mixtures	39 (30 ± 19)	5 (31 ± 17)	18 (24 ± 18)	13 (39 ± 21)
Rapid-acting	3 (17 ± 8)	1 (8 ± 0)	2 (22 ± 0)	0

Data shown are arithmetic means (±SD). Of a total of 69 patients with insulin treatment, 9 patients had HbA_1c <52 mmol/mol and 54 patients HbA_1c >52 mmol/mol. For three patients HbA_1c data were missing, and all of them were given an insulin mixture, while two of them were also on intermediate-acting insulin. No differences were observed between the groups regarding daily doses of insulin (P = 0.319).

IU: international units of insulin.

Table 3. Patients with diabetes vascular complications and hypoglycaemic episodes. The patients were divided into three groups by different HbA_1c levels.

Groups	All	HbA1c <52	HbA1c 52–73	HbA1c >73
Number of patients	218	94	78	28
Hypoglycaemia:
Patients with no hypoglycaemic events, n (%)	166 (76.1)	82 (87.2)^a	54 (69.2)	17 (60.7)
Patients with hypoglycaemic events, n (%)	52 (23.9)	12 (12.8)^a	24 (30.8)	11 (39.3)
Severe hypoglycaemic events:
Hypoglycaemia, hospitalization	10 (4.6)	3 (3.2)	2 (2.6)	5 (17.9)
Hypoglycaemia, emergency room	8 (3.7)	0	6 (7.7)	1 (3.6)
Hypoglycaemia, during hospital care	16 (7.3)	4 (4.3)	6 (7.7)	5 (17.9)
Minor hypoglycaemic events:
Hypoglycaemia, notes in medical records	33 (15.1)	7 (7.4)	17 (21.8)	8 (28.6)
Vascular complications:
No diabetes complications, n (%)	49 (22.5)	27 (28.7)	14 (17.9)	3 (10.7)
Complications from diabetes, n (%)	169 (77.5)	67 (71.3)	64 (82.1)	25 (89.3)
Microvascular complications, n (%)	45 (20.6)	14 (14.9)	17 (21.8)	10 (35.7)
Macrovascular complications, n (%)	74 (33.9)	38 (40.4)	25 (32.1)	7 (25.0)
Micro- and macrovascular complications, n (%)	50 (22.9)	15 (16.0)	22 (28.2)	8 (28.6)

Microvascular complications: retinopathy, nephropathy, neuropathy; macrovascular complication: myocardial infarction, instable angina pectoris, brain bleeding, brain infarction, TIA; hypoglycaemic episodes: plasma glucose <4 mmol/L.

^a Statistically significant difference (P < 0.05) between groups HbA_1c <52 and HbA_1c ≥52 mmol/mol. There were no hypoglycaemic episodes reported for patients with diet treatment only, except for two patients during hospital care.

Table 4. Hypoglycaemic episodes in subsets of patients given glucose-lowering pharmacological treatment. The patients were divided into three groups by different HbA_1c levels.

Groups	All	HbA1c <52	HbA1c 52–73	HbA1c >73
Number of patients	130	34	64	25
Hypoglycaemia:
Patients with no hypoglycaemic events, n (%)	80 (61.5)	24 (70.6)^a	40 (62.5)	14 (56.0)
Patients with hypoglycaemic events, n (%)	50 (38.5)	10 (29.4)^a	24 (37.5)	11 (44.0)
Severe hypoglycaemic events:
Hypoglycaemia, hospitalization, n (%)	9 (6.9)	2 (5.9)	2 (3.1)	5 (20.0)
Hypoglycaemia, emergency room, n (%)	8 (6.2)	0^a	6 (9.4)	1 (4.0)
Hypoglycaemia, during hospital care, n (%)	15 (11.5)	3 (8.8)	6 (9.4)	5 (20.0)
Minor hypoglycaemic events:
Hypoglycaemia, notes in medical records, n (%)	33 (25.4)	7 (20.6)^a	17 (26.6)	8 (32.0)

Hypoglycaemic episodes: plasma glucose <4 mmol/L.

^a Statistically significant difference (P < 0.05) between groups HbA_1c <52 and HbA_1c ≥52 mmol/mol.