High rate of hypoglycemia in 6770 type 2 diabetes patients with comorbid dementia: A multicenter cohort study on 215,932 patients from the German/Austrian diabetes registry

作者：Prinz Nicole^*; Stingl Julia; Dapp Albrecht; Denkinger Michael D; Fasching Peter; Jehle Peter M; Merger Sigrun; Muehldorfer Steffen; Pieper Urte; Schuler Andreas; Zeyfang Andrej; Holl Reinhard W

来源：Diabetes Research and Clinical Practice, 2016, 112: 73-81.

DOI：10.1016/j.diabres.2015.10.026

• Dementia
• Type 2 diabetes mellitus
• Hypoglycemia
• Diabetes-related complications
• Diabetes therapy
• Metabolic control

Aims: Dementia and type 2 diabetes (T2D) are two major phenomena in older people. To compare anti-hyperglycemic therapy and diabetes-related comorbidities between elderly T2D patients with or without comorbid dementia.
Methods: 215,932 type 2 diabetes patients aged >= 40 years (median [Q(1);Q(3)]: 70.4 [61.2;77.7] years) from the standardized, multicenter German/Austrian diabetes patient registry, DPV, were studied. To identify patients with comorbid dementia, the registry was searched by ICD-10 codes, DSM-IV/-5 codes, respective search terms and/or disease-specific medication. For group comparisons, multiple hierarchic regression modeling with adjustments for age, sex, and duration of diabetes was applied.
Results: 3.1% (n = 6770; 57% females) of the eligible T2D patients had clinically recognized comorbid dementia. After adjustment for demographics, severe hypoglycemia (insulin group: 14.8 +/- 0.6 vs. 10.4 +/- 0.2 events per 100 patient-years, p < 0.001), hypoglycemia with coma (insulin group: 7.6 +/- 0.4 vs. 3.9 +/- 0.1 events per 100 patient-years, p < 0.001), depression (9.9 vs. 4.7%, p < 0.001), hypertension (74.7 vs. 72.2%, p < 0.001), stroke (25.3 vs. 6.5%, p < 0.001), diabetic foot syndrome (6.0 vs. 5.2%, p = 0.004), and microalbuminuria (34.7 vs. 32.2%, p < 0.001) were more common in dementia patients compared to T2D without dementia. Moreover, patients with dementia received insulin therapy more frequently (59.3 vs. 54.7%, p < 0.001), but metabolic control (7.7 +/- 0.1 vs. 7.7 +/- 0.1%) was comparable to T2D without dementia.
Conclusions: In T2D with dementia, higher rates of hypoglycemia and other diabetes-related comorbidities were observed. Hence, the risks of a glucocentric and intense diabetes management with insulin and a focus on tight glycemic control without considering other factors may outweigh the benefits in elderly T2D patients with comorbid dementia.

• 出版日期2016-2