EPISODES OF HYPOGLYCEMIA IN PATIENTS WITH PARKINSON’S DISEASE: FINDINGS FROM A TWO-WEEK CONTINUOUS GLUCOSE MONITORING STUDY AT A TERTIARY CARE CENTRE

Abstract

Background: Parkinson’s disease (PD) is associated with a wide range of motor and non-motor manifestations, including autonomic dysfunction and metabolic abnormalities. Although hypoglycemia is traditionally considered predominantly in the context of diabetes mellitus, recent continuous glucose monitoring (CGM) studies suggest that clinically unrecognized glucose excursions may also occur in patients with PD. The present study evaluated the frequency, characteristics and clinical correlates of hypoglycemia detected by two-week CGM among patients with PD. Methods: A prospective observational study was conducted among 150 patients with clinically diagnosed PD attending a tertiary care centre over a four-month period. Demographic characteristics, disease duration, comorbidities, antiparkinsonian medications, levodopa-equivalent daily dose, motor severity assessed using the MDS-UPDRS Part III and Hoehn and Yahr staging, and autonomic dysfunction assessed using SCOPA-AUT were recorded. Participants underwent 14-day continuous glucose monitoring. CGM parameters included mean glucose, glycemic variability, time in range, time below range and the frequency, duration, severity and temporal distribution of hypoglycemic episodes. Hypoglycemia was defined as glucose <70 mg/dL, with <54 mg/dL considered level 2 hypoglycemia. Factors associated with hypoglycemia were evaluated using multivariable logistic regression. Results Among 150 participants, 78 (52.0%) experienced at least one CGM-detected hypoglycemic episode <70 mg/dL, while 39 (26.0%) experienced at least one episode <54 mg/dL. A total of 527 hypoglycemic episodes were detected, of which 421 (79.9%) were level 1 and 106 (20.1%) were level 2 episodes. Most episodes (84.1%) were asymptomatic. A marked nocturnal predominance was observed, with 214 (40.6%) episodes occurring between 00:00 and 06:00 and 312 (59.2%) between 18:00 and 06:00. Patients with hypoglycemia had longer PD duration (8.0 vs 6.2 years; p=0.008), higher MDS-UPDRS III scores (31.4 vs 25.6; p=0.003), greater levodopa-equivalent daily dose (754 vs 625 mg/day; p=0.012) and substantially higher prevalence of autonomic dysfunction (61.5% vs 29.2%; p<0.001). Mean CGM glucose was lower and glycemic variability was significantly greater among patients with hypoglycemia. In multivariable analysis, lower mean glucose, greater glycemic variability and higher SCOPA-AUT scores remained independently associated with hypoglycemia. Conclusion: Two-week CGM identified a substantial burden of predominantly asymptomatic and nocturnal hypoglycemia among patients with PD. Hypoglycemia was associated particularly with greater glycemic variability, disease severity and autonomic dysfunction, while conventional glycemic status alone did not adequately distinguish patients with and without hypoglycemia. CGM may therefore provide additional clinically relevant information in selected patients with PD, particularly those with advanced disease or prominent autonomic dysfunction.