Hypoglycaemia increases risk of adverse events in older patients with dementia

Mattishent K, Richardson K, Dhatariya K et al (2019) The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all-cause mortality in older individuals: A retrospective cohort study. Diabetes Obes Metab 21: 2076–85
 

• Dementia and diabetes are more common in older people and the numbers of individuals living with these conditions is rising year-on-year as a result of population ageing. The presence of dementia negatively impacts diabetes management, increasing the risk of hypoglycaemia and its associated complications. 
• In this retrospective cohort study, researchers investigated the association between hypoglycaemia and serious adverse events (cardiovascular events, falls, fractures and all-cause mortality) in older people with both diabetes and dementia. They also examined whether the presence of dementia had an impact on the consequences of hypoglycaemia.
• Participants were selected from the Clinical Practice Research Datalink database and allocated into a hypothetical target randomised controlled trial: the effect of hypoglycaemia in patients with dementia (trial 1) or adverse effects of hypoglycaemia based on dementia status (trial 2). The participants, intervention and follow-up of these trials mirrored each other. Adjusted hazard ratios were calculated for adverse effects.
• Hypoglycaemia was associated with an increased risk of all adverse events during the 1-year follow-up period in trial 1.
• Dementia increased the risk of falls, fractures and mortality but not cardiovascular events in the 12 months following a hypoglycaemic episode in trial 2.
• Hypoglycaemia was associated with an increased risk of subsequent complications in older people with diabetes and dementia, according to the authors, who propose future work on personalised diabetes management and monitoring strategies be carried out for this vulnerable group of patients.

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