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Hypoglycaemia increases risk of adverse events in older patients with dementia

Deintensifying treatment benefits older patients with type 2 diabetes

Innovative use of a flash glucose monitor in frail elderly patients: A case series

Through the use of flash glucose monitoring technology, this community nursing team has closely followed daily blood glucose patterns in their patients who need support to adminster their insulin, and has used them to adjust insulin regimens, thus reducing both the risk of hypoglycaemia (particularly nocturnal) and the number of nurse visits required.

Oral semaglutide significantly reduces cardiovascular events

An outcome study for oral semaglutide has evaluated the drug’s cardiovascular safety against placebo when added to standard care. Semaglutide is an injectable incretin that has recently become available; oral semaglutide has not yet been approved by the European Medicines Agency. Results showed no significant difference in three-point major adverse cardiac events, but there was a significant reduction in cardiovascular death and all-cause mortality with oral semaglutide.

Service update: The success of District Nursing virtual clinics in Somerset

Su Down examines the results of holding virtual clinics to reduce the demand on district nursing teams to administer insulin across rural Somerset.

New thinking in dementia and diabetes

An assessment of the evidence linking dementia to metabolic health and how lifestyle advice may offer hope to patients.

Diabetes and dementia: A double dilemma

An in-depth review of coexisting diabetes and dementia, and the implications for treatment.

Setting up a service for people with diabetes and dementia: Experiences from the DIADEM project

Amar Puttanna offers some practical suggestions on designing a service and managing patients with diabetes and dementia, drawing on his experience of creating the award-winning DIADEM project.

Diabetes and dementia: Personal and service impacts

Sara Da Costa introduces a special section on diabetes and dementia, asking how we can keep these patients at the centre of care in spite of insufficient resources and rising demand.

Dementia risk doubled in poorly controlled type 1 diabetes

Glycaemic control influences dementia risk in type 1 diabetes

Symptom burden greatest in undiagnosed diabetes

Applying evidence to improve diabetes care for older people

Glargine 300 units/mL reduces nocturnal hypoglycaemia in over 65s

Preventing misdiagnosis of diabetes in the elderly

Investigators examining increased HbA_1c levels in older people without diabetes have found a positive association between HbA_1c concentration and age in two independent population-based cohorts. This increase was observed equally in lean, overweight and obese individuals. Investigators used their findings to propose age-dependent reference values for HbA_1c and suggested that clinicians be made aware of this age-related increase in HbA_1c that is independent of diabetes. They propose that age-dependent reference intervals be used to improve patient care and the diagnosis of diabetes.

High blood glucose associated with excess mortality in older people

In this study investigators wanted to examine the relationship between HbA_1c, cardiovascular morbidity and all-cause mortality in older patients using insulin to treat type 2 diabetes, after adjusting for other factors. They examined a large GP database to gather information on patients aged over 65 treated with insulin. Both low and high HbA_1cwere found to be associated with increased all-cause mortality, with the greatest increase in risk seen at HbA_1c>96 mmol/mol (>11%). The lowest risk, in this U-shaped relationship, was seen in the 47.5–57.4 mmol/mol (6.5–7.4%) HbA_1crange.

Severe hypoglycaemia doubles dementia risk

Investigators wanted to discover whether there was an association between treatment choices for diabetes and dementia. They performed a systematic review and meta-analysis of pharmacological treatment of diabetes and incident or progressive cognitive impairment. Antidiabetic drug treatment was not generally associated with incident dementia. Differential effects were, however, found across drug classes, with insulin therapy being associated with a signal of harm and thiazolidinediones having potentially protective effects on cognition. There was nearly a twofold increase in the likelihood of incident dementia in those who experienced severe hypoglycaemic episodes.

Tight glycaemic control associated with mortality in older people

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