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Hypoglycemia, dementia linked in diabetic seniors

Monday June 10, 2013
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In older adults with diabetes mellitus, hypoglycemic events and dementia appear to be associated, according to a study.

There is a growing body of evidence that diabetes mellitus (DM) may increase the risk for developing cognitive impairment, including Alzheimer’s disease and vascular dementia, and there has been research interest in whether DM treatment can prevent cognitive decline, the authors noted in background information for the study, which was published June 10 on the website of JAMA Internal Medicine.

When blood glucose declines to low levels, cognitive function is impaired and severe hypoglycemia may cause neuronal damage. Previous research on the potential association between hypoglycemia and cognitive impairment has produced conflicting results.

Kristine Yaffe, MD, of the University of California, San Francisco, and colleagues studied 783 older adults with DM and an average age of 74. During a 12-year follow-up, 61 patients (7.8%) had a reported hypoglycemic event and 148 (18.9%) developed dementia.

"Hypoglycemia commonly occurs in patients with diabetes mellitus and may negatively influence cognitive performance," the authors wrote. "Cognitive impairment in turn can compromise DM management and lead to hypoglycemia."

Patients who experienced a hypoglycemic event had a two-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs. 17.6%), according to the study results. Older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with patients who did not develop dementia (14.2% vs. 6.3%).

The two-way association remained even after adjustment for age, sex, educational level, race/ethnicity, comorbidities and other covariates, the authors wrote. "These results provide evidence for a reciprocal association between hypoglycemia and dementia among older adults with DM."

In an invited commentary, Kasia J. Lipska, MD, MHS, of the Yale University School of Medicine in New Haven, Conn., and Victor M. Montori, MD, of the Mayo Clinic in Rochester, Minn., wrote: "Hypoglycemia in the course of type 2 DM treatment is both common and associated with poor outcomes. Therefore, decisions about the intensity and type of antihyperglycemic therapy must take into account the harms of hypoglycemia. Involving patients in these treatment decisions may favorably shift the current glucose-centric paradigm to a more holistic patient-centered one."

Read the study: http://archinte.jamanetwork.com/article.aspx?articleid=1696172.


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