Continuous glucose monitoring in well-controlled elderly patients with type 2 Diabetes Mellitus.

The current national primary care guideline recommends gliclazide as the second pharmacological step in diabetes management. Unfortunately, there is very limited data regarding hypoglycaemia rates in elderly patients using SUs. As more than one quarter of the type 2 diabetes population in the Netherlands is older than 75 years, differences in the frequency of hypoglycaemic events between SUs could be relevant. These events can be easily reported by the CGMS. Previous studies with CGMS already showed us that (asymptomatic) hypoglycaemic events are easily missed in elderly patients. However, these studies did not use an appropriate control group. Data regarding the effects of SUs, and specifically gliclazide, are needed for confirming the safety of gliclazide in frail elderly patients treated in primary care.

The aim of the current pilot study is to investigate the prevalence of (symptomatic) hypoglycaemia in frail elderly patients with type 2 diabetes treated with sulfonylurea and metformin, and to gather data for a full-scale hypothesis-testing study. The aim of this large powered study will be to compare differences in the prevalence of hypoglycemic events between the most commonly used sulfonylurea derivatives (SUs), glimepiride and gliclazide.

Visit 1: inclusion, informed consent, blood drawn for HbA1c measurement, Groningen Frailty index.
Visit 2 (day 1): baseline measurements, blood pressure measurements, CGMS implanted.
Day 1: CGMS implanted after breakfast, SMBG (4-5x);
Day 2: SMBG (N, VL, VA, VS);
Day 3: SMBG (N, VL, VA, VS);
Day 4: SMBG (N, VL, VA, VS);
Visit 3 (day 5): removal of CGMS, collection of patient diary.

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