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New diabetes technology can reduce risk of Hypoglycaemia in elderly patients

27 Jul 2021
Abu Dhabi

Hypoglycaemia, or low blood glucose, is an important complication that faces patients treated with insulin therapy and certain diabetes medications. The condition is more common in elderly patients and can lead to severe physical and cognitive impairment if left untreated, yet is largely underreported by patients. This is where diabetes education and the latest technology can have a big role to play in managing and preventing dangerous episodes, says an expert from Imperial College London Diabetes Centre (ICLDC), a Mubadala Health partner.

Dr Ahmed El-Laboudi, a consultant endocrinologist and diabetologist at ICLDC, explains that a blood sugar level of 70 milligrams per decilitre (mg/dL) or less is diagnostic of hypoglycaemia. Diabetes patients treated with insulin are more susceptible to hypoglycaemia as they age.

“Several factors, including the increased duration of diabetes and age-related physiological changes, make the elderly more prone to hypoglycaemia. Patients can experience multitude of symptoms including excessive sweating, dizziness, palpitations, nausea, visual disturbance and confusion when they are having an episode. The term ‘severe hypoglycaemia’ is used to describe an episode where the patient is confused or has lost consciousness and needs assistance to be treated,” he says. 

Hypoglycaemia can lead to devastating consequences for this age group. The inability to compose themselves during an attack can result in falls and fractures. It also increases the risk of life-threatening arrhythmias and studies have also shown a link to dementia.

“Recurrent hypoglycaemia can also result in a reduction or complete loss of awareness of all the warning signs, which increases the risk of exposure to severe episode.”

Along with patient education, new technologies to help manage blood glucose levels can be an ally in the care of the elderly with diabetes, alerting them when they are at risk and significantly improving their quality of life. 

One such technology is the continuous glucose monitoring (CGM). By measuring glucose level in tissue fluid every one to five minutes, this technology provides a complete picture of the patient’s glucose profile and allows them to recognise episodes of high or low glucose levels that are often missed. CGM systems can also be integrated with a patient’s insulin pump to automatically suspend insulin delivery and prevent a hypoglycaemic attack.

“Continuous glucose monitoring technology can be very liberating for people with diabetes who have frequent episodes of hypoglycaemia, not only because they help identify unrecognized hypoglycaemic episodes, but also because they are equipped with alarms that sound when hypoglycaemia is reached or predicted. This is particularly crucial for patients who may have an episode while asleep, or if they do not experience classic warning symptoms of hypoglycaemia,” adds Dr El-Laboudi. 

“CGM devices are valuable tools for physicians, too, because they are constantly relaying data points, such as when a patient is experiencing high or low blood sugar, and what is happening when they are asleep, when they eat and when they exercise. This insight can help us adjust therapy in a way that improves the patient’s control over their glucose levels without raising the risk of hypoglycaemia. Furthermore, CGM technology plays an essential role in an effective tele-medicine ecosystem and has shown its value during COVID-19 related lockdown, since CGM users can share their data remotely with healthcare team.”

ICLDC is seeing a growing number of patients in the UAE adopt glucose monitoring devices to manage their condition. The centre has more than 4,000 patients who use intermittently scanned CGM system (also known as flash glucose monitoring), allowing them to scan a tiny sensor inserted under the skin with a hand-held device ( or their mobile phones). This will give them their current reading, the last eight hours of glucose data and an indication of the direction in which their glucose is heading. The new version of the flash glucose monitoring system, which we will be launching at ICLDC soon, will also be equipped with alarm function.

Sharing an example of a 68-year-old patient who took control of her condition with the help of technology, Dr El-Laboudi says that many elderly patients believe hypoglycaemia is either something they must live with or tend to try to avoid by keeping their glucose levels high, which can cause a different set of complications. The centre’s multidisciplinary team, which includes diabetologists, endocrinologists, diabetes educators, dietitians and psychologists, provides patients with ongoing support and education to help them live well with diabetes.

“This patient believed that having episodes of low blood sugar was a trade-off that came with avoiding high blood sugar levels. She did not have many of the classical warming symptoms either, and did not realise the risk of frequent exposure to hypoglycaemia. But armed with the knowledge from our educators and data that she has been receiving from her device, she has been able to deal with them better and reduce future episodes.”

He concludes: “Since the discovery of insulin 100 years ago, diabetes care has come a long way. From technology to new generations of insulin and non-injectable therapy, there has been rapid progress in what we can now offer to patients so that they do not feel shackled by this disease.”

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