Impaired Awareness of Hypoglycemia in Older Adults with Type 1 Diabetes: A Post-hoc Analysis of the WISDM Study

Objective: Up to one-third of older adults with type 1 diabetes experience impaired awareness of hypoglycemic (IAH), yet the factors associated with IAH remain underexplored in older adults. Research Design and Methods: This post-hoc analysis evaluated the clinical and glycemic correlates of IAH in adults ≥60 years old with type 1 diabetes in the WISDM study. IAH and normal awareness (NAH) were defined by a Clarke score of ≥4 or <4, respectively. Demographic, clinical, and glycemic metrics were compared in those with IAH and NAH at baseline; and in whom IAH did or did not improve over 26 weeks using descriptive statistics and a multiple logistic regression variable selection procedure. Results: Of the 199 participants (age 68.1±5.7years, 52�male), 30.6% had IAH. At baseline, participants with IAH had a longer diabetes duration, greater daytime hypoglycemia and glycemic variability, and more participants had non-detectable C-peptide levels than those with NAH. Logistic regression associated longer diabetes duration (odds ratio [OR]:1.03, 95%CI,1.01–1.05, p=0.008) and greater daytime hypoglycemia (OR:1.31,95% CI,1.15–1.51, p<0.0001) with a greater odds of IAH. A similar modeling procedure identified less daytime hypoglycemia (OR per additional percentage point: 0.55, 95%CI; 0.32–0.94, p=0.029) and shorter diabetes duration (OR per additional year: 0.96, 95%CI, 0.91–1.004, p=0.07) as predictors of restored awareness at 26 weeks, although the effect size for diabetes duration was not statistically significant. Conclusion: In older adults with type 1 diabetes, longer diabetes duration and greater daytime hypoglycemia are drivers of IAH. Dedicated research can personalize IAH management.