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

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...

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Bibliographic Details
Published in:Diabetologia 2009-09, Vol.52 (9), p.1808-1815
Main Authors: Bruce, D. G., Davis, W. A., Casey, G. P., Clarnette, R. M., Brown, S. G. A., Jacobs, I. G., Almeida, O. P., Davis, T. M. E.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Cognition Disorders - epidemiology
Cognition Disorders - mortality
Cognitive ability
Dementia
Dementia - epidemiology
Diabetes
Diabetes Complications - epidemiology
Diabetes Complications - mortality
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - epidemiology
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Glycated Hemoglobin A - analysis
Health services
Hospitals
Human Physiology
Humans
Hypoglycemia
Hypoglycemia - epidemiology
Hypoglycemia - mortality
Hypoglycemic Agents - therapeutic use
Insulin - therapeutic use
Internal Medicine
Male
Medical sciences
Medicine
Medicine & Public Health
Mental Status Schedule
Metabolic Diseases
Older people
Patient Selection
Patients
Predictive Value of Tests
Prevalence
Probability
Regression Analysis
Self report
Sulfonylurea Compounds - therapeutic use
Surveys and Questionnaires
Survival Rate
Western Australia
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Summary: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.
ISSN:0012-186X
1432-0428
DOI:10.1007/s00125-009-1437-1