Hypoglycemia Is Linked to Frailty and Mortality in Diabetes

The risk of frailty and mortality are increased in patients with diabetes who experience a hypoglycemic event, according to a study published in the Journal of Diabetes and its Complications.

Researchers identified 210,254 patients from the Longitudinal Cohort of Diabetic Patients who had new onset diabetes between 2004 and 2011. Among this cohort there were 2,119 non-frail patients with at least one hypoglycemic episode within three years of the diabetes diagnosis. These patients were propensity score-matched to 8,432 non-frail patients who did not experience hypoglycemia during the study.

The study assessed incident physical frailty via a modified FRAIL scale (fatigue, resistance, ambulation, illness, and loss of weight). Meeting the FRAIL criteria for two of five categories equated to “the development of frailty,” and meeting the criteria for three of the five categories equated to incident frailty.

Mean patient age was 65.9 years. There were 126 diagnoses of incident frailty among those with a history of hypoglycemia and 46 among those with no history of hypoglycemia.

Patients with diabetes and hypoglycemia had a significantly higher comorbidity burden than those without hypoglycemia. After 2.68 years, 172 patients (1.6%) with hypoglycemia developed incident frailty—a 60% increase compared with those without hypoglycemia (hazard ratio [HR], 1.599; 95% confidence interval [CI], 1.14-2.42).

After adjusting for other risk factors, those with hypoglycemia had a significantly higher risk of frailty (primary endpoint) than those without hypoglycemia (HR, 1.443; 95% CI, 1.01-2.05). In addition, patients with hypoglycemia had a nearly twofold higher risk of mortality (secondary endpoint) compared with those without hypoglycemia (HR, 1.462; 95% CI, 1.3-1.65): 920 deaths occurred in patients with a history of hypoglycemia compared with 448 deaths in those without. This risk persisted despite adjusting for confounders.

“It will be interesting to speculate whether management and prevention of hypoglycemia may benefit those at a higher risk of developing frailty in this ever-increasing population,” the researchers concluded.