ArticleBMC endocrine disorders2026
Out of target glycemic control and severe hypoglycemia in older adults with diabetes presenting to the emergency department.
Article in BMC endocrine disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSevere hypoglycemia is a frequent and high-risk complication to treatment of diabetes in older adults. It is often related to strict glycemic targets, treatment intensification, and age-related physiological vulnerability. Long-term patterns of HbA1c concentrations before hypoglycemia-related hospital admissions remain poorly described. This study aimed to characterize pre-admission HbA1c concentration value trajectories in older individuals with diabetes and to explore if these patterns indicate overtreatment.
methodsWe performed a retrospective cohort study at the Emergency Department of North Zealand Hospital, Denmark. Patients aged ≥ 65 years admitted with severe hypoglycemia between 2021 and 2024 were included. Data were obtained from electronic systems. HbA1c concentration values from 0 to 5 years before admission were analyzed. Linear regression was used to estimate HbA1c concentration changes over time, stratified by diabetes type, HbA1c category ranges, and age.
resultsA total of 212 patients were included (68 with type 1 diabetes and 144 with type 2 diabetes), accounting for 301 hypoglycemia-related admissions and 2,574 HbA1c measurements. HbA1c distributions suggested overtreatment in both groups, particularly in type 2 diabetes, where 49% of admissions occurred with HbA1c < 53 mmol/mol and 26% <43 mmol/mol. Conversely, 27% of type 1 diabetes and 23% of type 2 diabetes were admitted with HbA1c > 70 mmol/mol. Longitudinal analyses demonstrated significant declines in HbA1c prior to admission among patients with low HbA1c at admittance. In type 1 diabetes, HbA1c declined markedly in the lowest two HbA1c groups (- 2.85 and - 2.75 mmol/mol per 100 days), while higher baseline groups showed stable-modestly increasing trajectories. In type 2 diabetes, HbA1c declined in admissions with baseline values ≤ 53 mmol/mol (- 0.46 to - 1.86 mmol/mol per 100 days), whereas admissions with higher baseline HbA1c showed increasing trajectories, most pronounced in those with HbA1c > 53 mmol/mol (+ 0.85 mmol/mol per 100 days).
conclusionsOur data suggest that a large fraction of admissions of older adults with severe hypoglycemia are associated with overtreatment, and could potentially have been prevented by due time treatment de-intensification. CLINICAL TRIAL NUMBER: Not applicable.
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