A greater incidence of hypoglycemia (low blood glucose) is linked to a higher risk for frailty and functional decline in older adults with type 2 diabetes, according to new research published in the journal Diabetes Research and Clinical Practice.
Hypoglycemia has long been known to be potentially dangerous in people with diabetes, and severe hypoglycemia is an emergency that requires immediate attention. But even episodes of mild to moderate hypoglycemia have been linked to worse outcomes in people with diabetes, indicating that the dangers of low glucose may outweigh the benefits of aiming to achieve a lower A1C level (a measure of long-term blood glucose control) in many cases. Both high and low glucose have been linked to a higher risk for dementia in people with type 1, and low glucose may also impair other cognitive functions even without dementia. The long-term dangers of hypoglycemia appear to be less clear in people with type 2 based on previous studies — while some studies support a direct link between low blood glucose and dementia in older adults with type 2, others suggest that the connection may be more of a coincidence. And while severe hypoglycemia and deaths in type 2 diabetes have recently gone up at the same time, it’s not clear that hypoglycemia is actually leading to these deaths.
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Frailty, functional decline linked to hypoglycemia
For the latest analysis, researchers looked at 11 studies that examined the risk for frailty or functional decline in older people with type 2 diabetes who experienced hypoglycemia. One study found that a greater incidence of hypoglycemia was linked to a 60% higher risk for frailty, as indicated by a clinical frailty scale that looked at different aspects of physical function. In four studies, hypoglycemia increased the risk for bone fractures by an average of 124%. And in a sixth study, hypoglycemia was linked to a higher risk for dependency on another person for everyday tasks.
Another five studies looked at the relationship between low blood glucose or A1C and frailty, rather than directly looking at the incidence of hypoglycemia. Out of these studies, one showed that as average blood glucose levels went down, the risk for frailty went up. Two studies showed a similar relationship between lower A1C and greater frailty, with an A1C level below 6.9% linked to a 41% higher risk for frailty. Another two studies showed that an A1C level below 6.5% was linked to an 8% higher risk for bone fractures, and that an A1C level below 6.0% was linked to a 245% higher likelihood of needing care from another person.
Taken together, these studies show that hypoglycemia is linked to a higher risk for frailty and other poor outcomes in older adults with type 2, although they don’t clearly show that low glucose is actually the cause of these risks. In any case, it may be worthwhile to discuss the risk of hypoglycemia with your doctor, especially since some diabetes treatments are carry a lower hypoglycemia risk than others.