Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

Abstract

Aims/hypothesis The aim was to investigate the relationship between severe hypoglycaemia and cognitive impairment in older patients with diabetes. Methods A sample of 302 diabetic patients aged ≥70 years was assessed for dementia or cognitive impairment without dementia in 2001-2002 and a subsample of non-demented patients (n=205) was followed to assess cognitive decline. A history of severe hypoglycaemia was determined from self-reports, physician assessments and records of health service use for hypoglycaemia (HSH). Prospective HSH was determined up to 2006. Data analysis, including multiple logistic and Cox regression models, was used to determine whether: (1) there were cross-sectional associations between hypoglycaemia and cognitive status, (2) historical hypoglycaemia predicted cognitive decline, and (3) baseline cognitive status predicted subsequent HSH.Results There were significant cross-sectional associations between both cognitive impairment and dementia and hypoglycaemia. Independent risk factors for future HSH included dementia (hazard ratio 3.00, 95% CI 1.06-8.48) and inability to self-manage medications (hazard ratio 4.17, 95% CI 1.43-12.13). However, there were no significant associations between historical hypoglycaemia, incident HSH and cognitive decline. Conclusions/interpretation Dementia is an important risk factor for hypoglycaemia requiring health service utilisation. We found no evidence that hypoglycaemia contributes to cognitive impairment in older patients with diabetes.

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

“…1,25 As mentioned, older persons with dementia are less able to effectively manage complex treatment regimens because of behavioral impairments, and, thus, recognize the symptoms of hypoglycemia and respond appropriately, increasing the risk for severe hypoglycemia. 2,5,17,25 Indeed, our findings confirmed that severe hypoglycemia was more prevalent among patients with dementia compared with patients without dementia. There is evidence that neuronal damage resulting from hypoglycemia is more vulnerable in those with diabetes, perhaps due to altered glucose metabolism.…”

“…2,3 However, this study did not test for different risks according to specific types of insulin or oral antidiabetic agents, probably because of the small study size (n ¼ 28). 2,3 Older nursing home patients represent a specific population of very frail individuals who need assistance in performing daily activities. Nursing home patients are closely monitored, and medically verified severe hypoglycemia is a validated finding compared with self-reported measures often used in community-dwelling population studies.…”

“…One study found that a small subgroup of community-dwelling elders with type 2 diabetes and dementia were at a threefold risk for a severe hypoglycemic event. 2 The authors also found that treatment with insulin was associated with an increased risk of hypoglycemia. 2,3 However, this study did not test for different risks according to specific types of insulin or oral antidiabetic agents, probably because of the small study size (n ¼ 28).…”

“…2 The authors also found that treatment with insulin was associated with an increased risk of hypoglycemia. 2,3 However, this study did not test for different risks according to specific types of insulin or oral antidiabetic agents, probably because of the small study size (n ¼ 28). 2,3 Older nursing home patients represent a specific population of very frail individuals who need assistance in performing daily activities.…”

Management of diabetes and dementia

“…[13][14][15] Patients with dysphasia may find it difficult to explain hypoglycaemic episodes even if they recognise it in the first place. Regular monitoring of the meter and discussions with carers should help highlight these episodes.…”