Abstract Body: Background: The ability of the body to maintain glucose homeostasis decreases with age, and symptoms of non-life-threatening hypoglycemia are non-specific (e.g. hunger, lack of concentration), which may put older adults at risk of hypoglycemia. The prevalence and correlates of symptoms of hypoglycemia in persons without diabetes are poorly understood.

Objective: To examine the prevalence and correlates of symptoms of hypoglycemia among older adults with and without diabetes.

Methods: Participants in the Atherosclerosis Risk in Communities (ARIC) Study (2021-22) with or without diabetes who were administered the 17-item Hypoglycemia Symptom Rating Questionnaire (HypSRQ) to assess symptoms of hypoglycemia experienced over the past 2 weeks. We quantified the burden of self-reported symptoms of hypoglycemia according to diabetes and high-risk diabetes medication status and evaluated the associations of symptoms with comorbidities including poor physical functioning (short physical performance summary battery score<7) and depression (CES-Depression scale score9).

Results: Among 1,085 participants (mean age 83, 60% female), 20.6% had diabetes (not on insulin/sulfonylurea (SU)) and 9% had diabetes (on insulin/SU). Overall, the number of symptoms reported were similar among those without diabetes (1.18 1.9 SD) and those with diabetes not taking insulin/SU (1.18 2.2) and higher among those with diabetes taking insulin/SU (1.41 2.0). Persons with diabetes (on insulin/SU) were more likely to report at least one symptom of hypoglycemia compared to persons with diabetes (not on insulin/SU) or without diabetes. Persons not on insulin/SU most commonly reported feelings of fatigue while persons on insulin/SU reported headaches, sudden temperature changes, feeling unsteady and faint (Figure). Irrespective of diabetes status, among those with 1 symptom (vs. none), 18% (vs. 14%) had poor physical functioning, 31% (vs. 23%) had obesity, and 6.5% (vs. 2.5%) had depression.

Conclusion: The burden of symptoms of hypoglycemia among very old adults is highest among those with type 2 diabetes and on high-risk diabetes medication. The most prevalent symptom reported differed by high-risk diabetes medication status. Hypoglycemic symptoms are non-specific in older adults who are often experiencing a high burden of comorbidities; therefore, it may be useful to screen for hypoglycemia in older, high-risk patients.