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ศุกร์, 08 พฤษภาคม 2009
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Hypoglycemia Increases Dementia Risk in Patients With Type 2 Diabetes
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News Author: Pauline Anderson
CME Author: Désirée Lie, MD, MSEd

Authors and Disclosures April 16, 2009 — Older adults with type 2 diabetes who experience an episode of hypoglycemia serious enough to require a trip to the emergency department or admission to the hospital are at increased risk of developing dementia, new research suggests.A study published in the April 15 issue of the Journal of the American Medical Association shows that the more of these episodes a patient suffers, the greater the chances of developing dementia, with at least 3 episodes almost doubling the risk.


The study found a 2.39%-per-year increase in absolute risk for dementia for patients with a history of hypoglycemia compared with patients with no history. While this does not seem large, the cumulative effect of this risk "would be sizable," say study authors led by Rachel A. Whitmer, PhD, an investigator from the division of research at Kaiser Permanente, in Oakland, California.

The findings "really add to the evidence base out there that perhaps very low glycemic targets might not be the best way to go in elderly patients with type 2 diabetes," said Dr. Whitmer in a video press release.


The study included 16,667 patients with type 2 diabetes who were members of Kaiser Permanente Northern California (KPNC), a nonprofit healthcare organization. At the start of the study in 1980, subjects had a mean age of 51 years and had no diagnosis of dementia or mild cognitive impairment.


Researchers used hospital records to gather information on hypoglycemia episodes from January 1, 1980 to December 31 2002. They also gathered data on dementia from inpatient and outpatient databases from January 1, 2003 to the end of the study period in mid-January 2007.


To adjust for comorbidities, researchers collected information on hypertension, heart disease, stroke, and end-stage renal disease from various databases and registries. They also gathered information on patient age, education, body-mass index, and ethnicity.


Treatments Evaluated

To evaluate diabetes treatments, including insulin, oral agents, and combined agents, investigators used the KPNC pharmacy databases from 2002 and 2003. They also created an insulin-duration variable that consisted of the number of years of insulin use between 1994 and the end of the study.


From 1980 to 2002, a total of 1465 patients (8.8%) had at least 1 episode of hypoglycemia. Of these patients, 1002 (68.5%) had 1 episode, 252 (18%) had 2 episodes, and 203 (13.5%) had 3 or more episodes. From January 1, 2003 to January 15, 2007, 1822 patients (11%) were diagnosed with dementia.


Compared with patients with no hypoglycemic episode, patients with 1 or more episodes had a graded increase in dementia risk. Adjusted hazard ratios were: 1.26 (95% CI, 1.10 – 1.49) for 1 episode; 1.80 (95% CI, 1.37 – 2.36) for 2 episodes; and 1.94 (95% CI, 1.42 – 2.64) for 3 or more episodes.


The researchers observed a 2.39% increase in absolute risk for dementia per year of follow-up for patients with history of hypoglycemia, compared with patients with no history of hypoglycemia (95% CI, 1.72 – 3.01).


Researchers tested a model that only considered hypoglycemia occurring from 1980 to 1985, when the patients were in their 50s and dementia unlikely. They still found an increased risk for dementia more than 2 decades later among patients who had experienced 1 or more episodes of hypoglycemia.

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