{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:16:59Z","timestamp":1792685819663,"version":"4.5.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study was conducted at King Abdullah University Hospital (KAUH) at the outpatient diabetes clinic from October 1st, 2022 to August 1st, 2023. Variables such as socio-demographics, medication history, and comorbidities were obtained using electronic medical records. The prevalence of hypoglycemia was determined through patient interviews during their clinic visit. Patients were prospectively monitored for hospital admissions, emergency department visits, and mortality using electronic medical records over a three-month follow-up period. Logistic regression models were conducted to identify factors associated with hypoglycemia and hospital admissions\/ emergency visits. Ethical Approval (Reference # 53\/151\/2022) was obtained on 19\/9\/2022.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Electronic medical charts of 640 patients who have type 2 diabetes mellitus and age \u2265 60 years were evaluated. The mean age \u00b1 SD was 67.19 (\u00b1 5.69) years. Hypoglycemia incidents with different severity levels were prevalent in 21.7% (n = 139) of the patients. Insulin administration was significantly associated with more hypoglycemic events compared to other antidiabetic medication. Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases. Patients with dyslipidemia also had a higher risk of hypoglycemia (odd ratio = 1.87). Regression analysis revealed that hypoglycemia and educational level were significant predictors for hospital admission and emergency department (ER) visits. Hypoglycemia was a positive predictor, meaning it increased the odds of these outcomes, while having a college degree or higher was associated with reduced odds of hospital admission and ER visits.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0309618","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T17:39:33Z","timestamp":1724953173000},"page":"e0309618","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8426-0034","authenticated-orcid":true,"given":"Ahmad","family":"Al-Azayzih","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roaa J.","family":"Kanaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoroq M.","family":"Altawalbeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karem H.","family":"Alzoubi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelal","family":"Kharaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anan","family":"Jarab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,29]]},"reference":[{"issue":"Suppl 1","key":"pone.0309618.ref001","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.2337\/dc21-S006","article-title":"6. Glycemic Targets: Standards of Medical Care in Diabetes-2021","volume":"44","author":"American Diabetes A","year":"2021","journal-title":"Diabetes Care"},{"issue":"7","key":"pone.0309618.ref002","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1007\/s13300-021-01054-6","article-title":"The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective","volume":"12","author":"H Gelhorn","year":"2021","journal-title":"Diabetes Ther"},{"issue":"7","key":"pone.0309618.ref003","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1001\/jamainternmed.2016.2275","article-title":"Intensive Treatment and Severe Hypoglycemia Among Adults With Type 2 Diabetes","volume":"176","author":"RG McCoy","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"2","key":"pone.0309618.ref004","doi-asserted-by":"crossref","first-page":"e220262","DOI":"10.1001\/jamanetworkopen.2022.0262","article-title":"Analysis of Severe Hypoglycemia Among Adults With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease","volume":"5","author":"JY Lee","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"6","key":"pone.0309618.ref005","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.2215\/CJN.00800209","article-title":"Frequency of hypoglycemia and its significance in chronic kidney disease","volume":"4","author":"MF Moen","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"pone.0309618.ref006","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.dsx.2018.05.011","article-title":"Hypoglycemia and cognitive function in diabetic patients","volume":"12","author":"SA Ebadi","year":"2018","journal-title":"Diabetes Metab Syndr"},{"issue":"1","key":"pone.0309618.ref007","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ando.2023.10.006","article-title":"Effect of hypoglycemia on cognitive performance in older patients with diabetes: A meta-analysis","volume":"85","author":"Z Mu","year":"2024","journal-title":"Ann Endocrinol (Paris)"},{"issue":"2","key":"pone.0309618.ref008","doi-asserted-by":"crossref","first-page":"e13248","DOI":"10.1111\/ijn.13248","article-title":"Hypoglycaemia fear, treatment adherence, and the quality of life in patients with type 2 diabetes and its determinants","volume":"30","author":"D Yildirim","year":"2024","journal-title":"Int J Nurs Pract"},{"issue":"1","key":"pone.0309618.ref009","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2337\/dc17-1669","article-title":"The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes","volume":"41","author":"AK Lee","year":"2018","journal-title":"Diabetes Care"},{"issue":"5","key":"pone.0309618.ref010","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S2213-8587(18)30315-2","article-title":"Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management","volume":"7","author":"International Hypoglycaemia Study G","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"2","key":"pone.0309618.ref011","doi-asserted-by":"crossref","first-page":"156","DOI":"10.14336\/AD.2014.0330","article-title":"Hypoglycemia in older people\u2014a less well recognized risk factor for frailty","volume":"6","author":"AH Abdelhafiz","year":"2015","journal-title":"Aging Dis"},{"issue":"3","key":"pone.0309618.ref012","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2337\/diab.43.3.403","article-title":"Counterregulatory hormone responses to hypoglycemia in the elderly patient with diabetes","volume":"43","author":"GS Meneilly","year":"1994","journal-title":"Diabetes"},{"issue":"4","key":"pone.0309618.ref013","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/00325481.2019.1578590","article-title":"Management of hypoglycemia in older adults with type 2 diabetes","volume":"131","author":"J. Freeman","year":"2019","journal-title":"Postgrad Med"},{"issue":"11","key":"pone.0309618.ref014","doi-asserted-by":"crossref","DOI":"10.3390\/nu12113367","article-title":"Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty","volume":"12","author":"Y Tamura","year":"2020","journal-title":"Nutrients"},{"issue":"8","key":"pone.0309618.ref015","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11892-018-1018-0","article-title":"Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies","volume":"18","author":"R Silbert","year":"2018","journal-title":"Curr Diab Rep"},{"issue":"1","key":"pone.0309618.ref016","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2337\/dc16-2215","article-title":"Glucose Concentrations of Less Than 3.0 mmol\/L (54 mg\/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes","volume":"40","author":"G. International Hypoglycaemia Study","year":"2017","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0309618.ref017","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0253-7176.116232","article-title":"How to calculate sample size for different study designs in medical research?","volume":"35","author":"J Charan","year":"2013","journal-title":"Indian J Psychol Med"},{"issue":"13","key":"pone.0309618.ref018","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1001\/archinte.161.13.1653","article-title":"Hypoglycemia in patients with type 2 diabetes mellitus","volume":"161","author":"CD Miller","year":"2001","journal-title":"Arch Intern Med"},{"issue":"6","key":"pone.0309618.ref019","doi-asserted-by":"crossref","first-page":"e0126427","DOI":"10.1371\/journal.pone.0126427","article-title":"Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and Meta-Analysis of Population Based Studies","volume":"10","author":"CL Edridge","year":"2015","journal-title":"PLoS One"},{"key":"pone.0309618.ref020","doi-asserted-by":"crossref","first-page":"2150132719880638","DOI":"10.1177\/2150132719880638","article-title":"Prevalence of Hypoglycemia Among Patients With Type 2 Diabetes Mellitus in a Rural Health Center in South India","volume":"10","author":"V Samya","year":"2019","journal-title":"J Prim Care Community Health"},{"key":"pone.0309618.ref021","doi-asserted-by":"crossref","first-page":"1222409","DOI":"10.3389\/fendo.2023.1222409","article-title":"Association of hypoglycaemia with the risks of arrhythmia and mortality in individuals with diabetes\u2014a systematic review and meta-analysis","volume":"14","author":"G Li","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0309618.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/j.deman.2023.100162","article-title":"Severe hypoglycemia and falls in older adults with diabetes: The Diabetes & Aging Study","volume":"12","author":"HH Moffet","year":"2023","journal-title":"Diabet Epidemiol Manag"},{"issue":"11","key":"pone.0309618.ref023","doi-asserted-by":"crossref","first-page":"e024909","DOI":"10.1136\/bmjopen-2018-024909","article-title":"Use of multiple antidiabetic medications in patients with diabetes and its association with hypoglycaemic events: a case-crossover study in Jordan","volume":"8","author":"AY Naser","year":"2018","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0309618.ref024","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1007\/s13300-018-0482-5","article-title":"Comparison of Oral Antidiabetic Drugs as Add-On Treatments in Patients with Type 2 Diabetes Uncontrolled on Metformin: A Network Meta-Analysis","volume":"9","author":"D Qian","year":"2018","journal-title":"Diabetes Ther"},{"issue":"4","key":"pone.0309618.ref025","doi-asserted-by":"crossref","first-page":"167","DOI":"10.24171\/j.phrp.2018.9.4.05","article-title":"Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications","volume":"9","author":"M Haghighatpanah","year":"2018","journal-title":"Osong Public Health Res Perspect"},{"issue":"1","key":"pone.0309618.ref026","doi-asserted-by":"crossref","first-page":"e000512","DOI":"10.1136\/bmjdrc-2018-000512","article-title":"Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study","volume":"6","author":"J Gordon","year":"2018","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"8","key":"pone.0309618.ref027","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1080\/03007995.2016.1176017","article-title":"Association between hypoglycemia risk and hemoglobin A1C in patients with type 2 diabetes mellitus","volume":"32","author":"S Yu","year":"2016","journal-title":"Curr Med Res Opin"},{"issue":"1","key":"pone.0309618.ref028","article-title":"Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus","volume":"9","author":"MJY Zhao","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"1","key":"pone.0309618.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/2230-8210.126517","article-title":"The hypoglycemic side of hypothyroidism","volume":"18","author":"S Kalra","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"key":"pone.0309618.ref030","article-title":"Hypoinsulinemic hypoglycemia triggered by liver injury in elderly subjects with low body weight: case reports","volume":"2018","author":"T Anno","year":"2018","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"issue":"1","key":"pone.0309618.ref031","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1159\/000322886","article-title":"Hypoglycemia: A Possible Link between Insulin Resistance, Metabolic Dyslipidemia, and Heart and Kidney Disease (the Cardiorenal Syndrome)","volume":"1","author":"M Ensling","year":"2011","journal-title":"Cardiorenal Med"},{"issue":"11","key":"pone.0309618.ref032","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.amjmed.2019.04.050","article-title":"High-Intensity Statins Are Associated With Increased Incidence of Hypoglycemia During Hospitalization of Individuals Not Critically Ill","volume":"132","author":"I Khanimov","year":"2019","journal-title":"Am J Med"},{"issue":"4","key":"pone.0309618.ref033","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.curtheres.2010.08.002","article-title":"Effects of ezetimibe on glucose metabolism in patients with type 2 diabetes: A 12-week, open-label, uncontrolled, pilot study","volume":"71","author":"T Nozue","year":"2010","journal-title":"Curr Ther Res Clin Exp"},{"issue":"12","key":"pone.0309618.ref034","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s11892-018-1101-6","article-title":"Pathogenesis of Lipid Disorders in Insulin Resistance: a Brief Review","volume":"18","author":"P Bjornstad","year":"2018","journal-title":"Curr Diab Rep"},{"issue":"2","key":"pone.0309618.ref035","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2337\/diaclin.34.2.97","article-title":"Treatment Approach to Patients With Severe Insulin Resistance","volume":"34","author":"TJ Church","year":"2016","journal-title":"Clin Diabetes"},{"issue":"1","key":"pone.0309618.ref036","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12245-018-0186-7","article-title":"Frequency of return visits to the emergency department in patients discharged following hypoglycemia episodes","volume":"11","author":"DP Betten","year":"2018","journal-title":"Int J Emerg Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309618","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T17:39:55Z","timestamp":1724953195000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309618"}},"subtitle":[],"editor":[{"given":"Miquel","family":"Vall-llosera Camps","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,29]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0309618","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,29]]}}}