TY - JOUR
T1 - 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
AU - Barbagallo, Mario
AU - Maggi, Stefania
AU - Abbatecola, Angela Marie
AU - Bellelli, Giuseppe
AU - Bo, Mario
AU - Incalzi, Raffaele Antonelli
AU - Pilotto, Alberto
AU - Paolisso, Giuseppe
PY - 2015
Y1 - 2015
N2 - Objectives: 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. Design: Cross-sectional observational study. Setting: A total of 150 nursing homes across Italy. Participants: A total of 2258 patients with type 2 diabetes (dementia=1138, no dementia=1120). Measurements: 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% (54mmol/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. Conclusion: 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.
AB - Objectives: 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. Design: Cross-sectional observational study. Setting: A total of 150 nursing homes across Italy. Participants: A total of 2258 patients with type 2 diabetes (dementia=1138, no dementia=1120). Measurements: 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% (54mmol/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. Conclusion: 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.
KW - 80 and over; Blood Glucose; Confidence Intervals; Cross-Sectional Studies; Dementia; Diabetes Mellitus
KW - Aging; Antidiabetic oral agents; Dementia; Insulin analogs; Severe hypoglycemia; Administration
KW - Oral; Age Distribution; Aged; Aged
KW - Type 2; Female; Homes for the Aged; Humans; Hypoglycemia; Hypoglycemic Agents; Insulin; Insulin Antagonists; Italy; Logistic Models; Male; Middle Aged; Nursing Homes; Odds Ratio; Prevalence; Prognosis; Reference Values; Risk Assessment; Severity of Illnes
KW - 80 and over; Blood Glucose; Confidence Intervals; Cross-Sectional Studies; Dementia; Diabetes Mellitus
KW - Aging; Antidiabetic oral agents; Dementia; Insulin analogs; Severe hypoglycemia; Administration
KW - Oral; Age Distribution; Aged; Aged
KW - Type 2; Female; Homes for the Aged; Humans; Hypoglycemia; Hypoglycemic Agents; Insulin; Insulin Antagonists; Italy; Logistic Models; Male; Middle Aged; Nursing Homes; Odds Ratio; Prevalence; Prognosis; Reference Values; Risk Assessment; Severity of Illnes
UR - http://hdl.handle.net/10447/297476
M3 - Article
VL - 16
SP - 349.e7-349.e12
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
SN - 1525-8610
ER -