Older patients with diabetes are more likely to develop dementia if
they suffer severe hypoglycaemia, and in turn, more likely to have
subsequent hypoglycaemic events if they develop dementia, shows a US
study.
The study
Researchers
followed up 783 older adults with diabetes, aged an average of 74 years
and free of dementia at baseline, for 12 years, to examine the
relationship between hypoglycaemia and dementia.
The findings
A
total of 61 (7.8%) individuals had a reported hypoglycaemic event that
required hospitalisation over the 12-year follow-up, of whom 21 (2.7%)
had more than one such event, and 148 (18.9%) individuals developed
dementia. Those with a severe hypoglycaemic event were significantly
more likely to develop dementia, with a rate of 34.4% compared with
17.6% among those who did not have a reported hypoglycaemic event.
After
multivariable adjustment for confounders including age, sex, education,
insulin use, race/ethnicity, lipid levels, HbA1c levels and baseline
cognitive function, the risk of dementia was doubled among those who had
a severe hypoglycaemic event, compared with those who did not.
Similarly, the rate of hypoglycaemic events causing hospitalisation was
higher among individuals with dementia, compared with those without
dementia, at 14.2% and 6.3%, respectively. After multivariable
adjustment, the risk of a subsequent severe hypoglycaemic event was
three-fold greater among those with a preceding dementia diagnosis than
those without.
What this means for GPs
The
researchers concluded: ‘Hypoglycaemia may impair cognitive health, and
reduced cognitive function may increase the risk for a hypoglycaemic
event that could further compromise cognition, resulting in a
detrimental cycle.’ Authors of a related editorial commented: ‘Efforts
to mitigate the risk of hypoglycaemia are clearly warranted to improve
quality of life and potentially prevent the associated adverse events.
After problem solving through fixable causes of hypoglycaemia, patients
and clinicians should consider setting higher HbA1c targets that may
yield a safer management programme.’
Information source here.
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