Hypoglycaemia: especially dangerous in dementia

Severe hypoglycaemia is more deadly in people with diabetes and dementia than in those with diabetes alone, according to research presented at the European Association for the Study of Diabetes meeting in Berlin recently.

“Hypoglycaemia is an underrecognised risk factor for death in older adults with diabetes and dementia,” says study author Katharina Mattishent, Norwich Medical School, University of East Anglia.

“Treatment strategies aimed at minimising hypoglycaemia should be prioritised in older patients with diabetes and dementia who are already prone to suffer from cardiovascular events, falls and fractures.”

Researchers followed 19,995 patients with type 1 or type 2 diabetes aged 65 years or older for up to five years after their first hypoglycaemic episode. The analysis adjusted for confounders including age, sex, demographics, co-morbidities and medications. During the study, 11,716 people died.

Patients with diabetes and dementia were 66 per cent more likely to die after hypoglycaemia than those with diabetes and dementia who did not experience hypoglycaemia.

Following hypoglycaemia, patients with diabetes and dementia were 67 per cent more likely to die than diabetics who did not have dementia.

“Given the continuous rise in diabetes and dementia prevalence and the ageing population, strategies to prevent and reduce hypoglycaemia in older people with dementia and diabetes must be a top priority,” Dr Mattishent adds.

“In this vulnerable group, clinicians and patients should move away from ... strict glucose-lowering targets. The focus must be directed at rigorous detection of hypoglycaemia using continuous glucose monitoring devices. This close monitoring will guide treatment choices with regards to drugs that have a low risk of hypoglycaemia in this patient group.”

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