Older people with diabetes and co-morbid illnesses are especially susceptible to severe hypoglycemia. They have fewer warning symptoms when they experience mild dips in blood sugar, and this leaves less time for them to react and treat the problem before it becomes severe.

In a study published in JAMA Internal Medicine, a cross-sectional analysis of the data on 1288 older adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2010 revealed, there were no significant changes in the proportion of older adults with an HbA1c level of less than 7% (P = .34), the proportion with an HbA1c level of less than 7% who had complex/intermediate or very complex/poor health (P = .27), or the proportion with an HbA1c level of less than 7% who were treated with insulin or sulfonylureas despite having complex/intermediate or very complex/poor health (P = .65).

Thus, 62 percent of adults over age 65 had A1c seven and there was absolutely no difference in how people were treated based on their health. Patients in poor health and at risk for hypoglycemia were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia suggesting that a substantial proportion of older adults with diabetes were potentially over treated.

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