title: Severe hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the DIMORA study.
abstract: OBJECTIVE
  Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  A total of 150 nursing homes across Italy.
  
  
  METHODS
  A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120).
  
  
  METHODS
  Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents.
  
  
  RESULTS
  Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia.
  
  
  CONCLUSIONS
  In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer.
authors: Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy. Electronic address: angela_abbatecola@yahoo.com.
authors: Angela Marie
authors: AM
authors: Abbatecola
authors: Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors: Mario
authors: M
authors: Bo
authors: Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
authors: Mario
authors: M
authors: Barbagallo
authors: Department of Geriatrics, Campus Bio-Medico University, Rome, Italy.
authors: Raffaele Antonelli
authors: RA
authors: Incalzi
authors: Azienda ULSS, Geriatrics Unit, St. Antonio Hospital, Padua, Italy.
authors: Alberto
authors: A
authors: Pilotto
authors: Department of Health Sciences, University of Milano-Bicocca, Milan, Italy; Acute Geriatric Unit, S Gerardo Hospital, Monza, Italy; Milan Center for Neuroscicence (Neuro-Mi), Milan, Italy.
authors: Giuseppe
authors: G
authors: Bellelli
authors: National Research Council (CNR), Neuroscience Institute Aging Branch, Padua, Italy.
authors: Stefania
authors: S
authors: Maggi
authors: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors: Giuseppe
authors: G
authors: Paolisso
mesh_terms: D000284:Administration, Oral; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007329:Insulin Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007329:Insulin Antagonists; D013453:Sulfonylurea Compounds
keywords: Severe hypoglycemia; aging; antidiabetic oral agents; dementia; insulin analogs