title: 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.
abstract: OBJECTIVE
  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 [Q1;Q3]: 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.
authors.affiliation: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany. Electronic address: nicole.prinz@uni-ulm.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Prinz
authors.affiliation: Federal Institute for Drugs and Medical Devices, and Faculty of Medicine, University of Bonn, Bonn, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Stingl
authors.affiliation: Diabetes Center, Hospital District Tuttlingen, Medical Clinic Spaichingen, Spaichingen, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Dapp
authors.affiliation: Geriatric Center Ulm/Alb-Donau, Geriatric Medicine at Ulm University, Agaplesion Bethesda Hospital Ulm, Ulm, Germany.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Denkinger
authors.affiliation: 5th Medical Department, Wilhelminenspital, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Fasching
authors.affiliation: Department of Internal Medicine, Paul-Gerhardt-Stift, Academic hospital of the Martin-Luther-University Halle-Wittenberg, Lutherstadt Wittenberg, Germany.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jehle
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Merger
authors.affiliation: Department of Internal Medicine I, Hospital Bayreuth, Bayreuth, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Mühldorfer
authors.affiliation: Department of Internal Medicine, Hospital Wolgast, Wolgast, Germany.
authors.forename: Urte
authors.initials: U
authors.lastname: Pieper
authors.affiliation: Department of Internal Medicine, Helfenstein Hospital Geislingen/Steige, Geislingen/Steige, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuler
authors.affiliation: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany; Agaplesion Bethesda Hospital Stuttgart, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Zeyfang
authors.affiliation: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Dementia; Diabetes therapy; Diabetes-related complications; Hypoglycemia; Metabolic control; Type 2 diabetes mellitus