Severe hypoglycemia has much more serious consequences in people who have both diabetes and dementia than those with diabetes alone, according to new research.
The study, conducted in the U.K., found that following hypoglycemia, older adults with both diabetes and dementia were 67% more likely to die compared to those with diabetes alone.
“Hypoglycaemia is an under-recognized risk factor for death in older adults with diabetes and dementia,” says Dr. Katharina Mattishent, lead researcher of the study and an Alzheimer’s Society Clinical Research Fellow from Norwich Medical School, University of East Anglia, in Norwich, U.K.
“Treatment strategies aimed at minimizing hypoglycemia should be prioritized in older patients with diabetes and dementia who are already prone to suffer from cardiovascular events, falls, and fractures,” she states.
A recent meta-analysis involving almost 1.5 million adults found that hypoglycemia is linked with an increased risk of death, cardiovascular events, falls, and fractures.
However, none of the studies examined these outcomes in specific groups of people at particularly high risk of hypoglycemia, such as those with dementia and diabetes.
What was the Study Design?
To investigate this further, Mattishent and colleagues analyzed data from 19,995 patients with Type 1 or Type 2 diabetes aged 65 years or older both with and without dementia who were diagnosed with the first hypoglycemic episode between April 1997 and 31 March 2016.
The study was carried out using the UK Clinical Practice Research Datalink (CPRD), the world’s largest primary care database, and data on hospital admission from the Hospital Episode Statistics (HES).
The researchers followed participants for up to 5 years after their first recorded hypoglycemic episode to examine whether hypoglycemic episodes were associated with death from any cause in patients with dementia and diabetes and whether hypoglycemic episodes had a different impact on mortality in diabetics with and without dementia.
What were the Findings?
The results were adjusted for influential factors including age, sex, sociodemographics, comorbidities, and medications. Over the study period, 11,716 people died from any cause.
Following hypoglycemia, patients with diabetes and dementia had a 66% greater risk of death as those who did not experience hypoglycemia (1369 deaths/1679 patients vs 3853 deaths/6134 patients).
The analysis also found that, following hypoglycemia, diabetics with dementia were 66% more likely to die as those without dementia (1369 deaths/1679 patients vs 6494 deaths/12182 patients).
What are the Conclusions?
“Given the continuous rise in diabetes and dementia prevalence and the aging population, strategies to prevent and reduce hypoglycemia in older people with dementia and diabetes must be a top priority,” Mattishent concludes.
She indicates in this vulnerable group, clinicians and patients should move away from the relentless pursuit of strict glucose-lowering targets.
“The focus must be directed at rigorous detection of hypoglycemia using continuous glucose monitoring devices,” she points out. “This close monitoring will guide treatment choices with regards to drugs that have a low risk of hypoglycemia in this patient group.”
This is an observational study, so no firm conclusions can be drawn about cause and effect and the authors point to several limitations.
First, the databases may not have captured all hypoglycemia events. Furthermore, lifestyle factors, such as smoking, exercise, and alcohol use may not have been reliably entered on the database.
Finally, the CPRD database does not specify the severity of dementia and the authors are therefore not able to assess whether the risks are worse with severe dementia.
The research was presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin, Germany (1-5 October).
- “Link between low blood glucose and death in people with diabetes and dementia revealed.” October 1, 2018. Diabetologia. Retrieved: https://www.eurekalert.org/pub_releases/2018-10/d-lbl092818.php