Severe Hypoglycemia and Cognitive Decline in Older People With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

Abstract

OBJECTIVEPeople with type 2 diabetes are at increased risk of age-related cognitive decline and dementia. Hypoglycemia is a candidate risk factor, but the direction of association between episodes of severe hypoglycemia and cognitive decline in type 2 diabetes remains uncertain. RESEARCH DESIGN AND METHODSIn the Edinburgh Type 2 Diabetes Study, cognitive function was assessed in 831 adults with type 2 diabetes (aged 60-75 years) at baseline and after 4 years. Scores on seven neuropsychological tests were combined into a standardized general ability factor g. Self-reported history of severe hypoglycemia at baseline (history of hypoglycemia) and at follow-up (incident hypoglycemia) was recorded. RESULTSA history of hypoglycemia was reported by 9.3% of subjects, and 10.2% reported incident hypoglycemia. Incident hypoglycemia was associated with poorer cognitive ability at baseline (age-and sex-adjusted odds ratio for lowest tertile of g 2.04 [95% CI 1.25-3.31], P = 0.004). Both history of hypoglycemia and incident hypoglycemia were also associated with greater cognitive decline during followup (mean follow-up g adjusted for age, sex, and baseline g 20. CONCLUSIONSThe relationship between cognitive impairment and hypoglycemia appeared complex, with severe hypoglycemia associated with both poorer initial cognitive ability and accelerated cognitive decline. Diabetes Care 2014;37:507-515 | DOI: 10.233737:507-515 | DOI: 10. /dc13-1384 Type 2 diabetes is associated with an increased risk of cognitive impairment, agerelated cognitive decline, and dementia (1). Given the increasing numbers of elderly people with type 2 diabetes in the general population, the identification of potentially modifiable risk factors and the prevention of cognitive decline during older age in this group are of major importance to public health. Although the

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.…”

Association Between Severe Hypoglycemia, Adverse Macrovascular Events, and Inflammation in the Edinburgh Type 2 Diabetes Study

“…Another unresolved issue in the current study is whether a baseline history of severe hypoglycemia was merely a predictor of incident hypoglycemic events (during the 4-year followup), suggesting a role for incident hypoglycemic events in the association with macrovascular events and in the production of any potentially mediating proinflammatory state. Although 39% of participants with a history of severe hypoglycemia at baseline had an incident severe hypoglycemic event, the absolute number of incident events in people who also had experienced a macrovascular event was too small for meaningful analysis (30).…”

Clinical value of glargine 300 U/mL based on randomized trials and routine medical practice

“…This was shown to threaten their lives (risk of death increased two-fold) and cause brain damage, impairing their cognitive skills and facilitating development of dementia [24]. Occurrence of hypoglycemia has negative effect on quality of life of patients and their social functioning [25,26].…”