Hypoglycaemia in Diabetes and Dementia Population

Abstract

BACKGROUND: Diabetes mellitus (DM) and dementia are common long-term conditions that co-exist in a large proportion of the elderly. Diabetic patients with dementia may be less able to self-manage and control their diabetes, placing them at a higher risk of complications such as hypoglycaemia. AIM: This thesis aimed to investigate the risk of hypoglycaemia associated with dementia diagnosis among patients with DM. METHODS: This thesis describes work conducted using The IQVIA Medical Research Data (IMRD)‐UK database. Firstly, a descriptive, population-based study was conducted to estimate the prevalence and incidence of dementia in the diabetes population. Secondly, a descriptive, drug utilisation study was conducted to describe the prescribing pattern of antidiabetic medications and the rate of hypoglycaemia. Thirdly, a cohort study was conducted to investigate the association between dementia diagnosis and hypoglycaemia among patients with DM. Finally, a retrospective, pre-post exposure study was conducted to explore the glycaemic control and the rate of hypoglycaemia in diabetes patients pre- and post-dementia diagnosis. RESULTS: There was a trend of increasing prevalence and incidence of dementia, annual antidiabetic medication prescribing and hypoglycaemia rate in patients diagnosed with both DM and dementia over the period of 2000–2016. Patients diagnosed with dementia were at a twofold increased risk for hypoglycaemic events compared with those not diagnosed with dementia for whom the adjusted hazards ratio (HR) was 2.00 (95% CI,1.63–2.66). Glycaemic control was tighter in patients after dementia diagnosis compared to glycaemic control before dementia diagnosis. The rate of hypoglycaemia six months after dementia diagnosis was significantly higher at 3.05% (95% CI 3.0%–3.1%) compared to the rate of hypoglycaemia before dementia diagnosis at 2.18% (95% CI 2.1%–2.2%). Conclusion: This project highlighted the clinical impact of dementia on patients with DM and confirmed that dementia was associated with an increased risk of hypoglycaemia. Therefore, physicians need to take extra care regarding diabetes management, especially for patients who have been diagnosed with dementia.