Many Older Veterans With Diabetes and Dementia May Have Tighter Glucose Control Than Is Safe
What to Know
Diabetes increases the risk of dementia, a group of age-related mental disorders that includes memory problems, personality changes, and reasoning difficulties. About a quarter of people over 75 with diabetes also have dementia. Such people often have particular trouble preventing hypoglycemia (low blood glucose) due to too strict blood glucose control, other medications, and additional factors. This study examined such factors to determine their impact on the risk for hypoglycemia.
The researchers reviewed the 2008 and 2009 medical records of 15,880 veterans and divided them according to their level of glucose control (tight, moderate, poor, or not monitored). All were 65 or older, had diabetes and dementia, and were taking diabetes medications. The researchers looked for links between the patients' personal and health characteristics and their level of glucose control. For patients in the tight control group, they also looked at how many took medicines in the sulfonylurea class and if they took insulin. Finally, they looked for links between their personal and health characteristics and their use of these diabetes medicines.
Fifty two percent of the patients had tight glycemic control. Older patients, those who had recently lost weight, or who had other health conditions, like heart valve disease, lung disease, or anemia, were more likely to have tight glucose control. Seventy five percent of patients with tight blood glucose control used a sulfonylurea and/or insulin. Those who were male, black, were 75 years of age or older, had had a recent hospital or nursing stay, or had congestive heart failure, kidney failure, or peripheral vascular disease were more likely to be using a sulfonylurea and/or insulin.
More than half of older veterans with diabetes and dementia have tight glucose control even though a more relaxed level of control is recommended. This raises their risk of hypoglycemia. Of those with tight control, three-fourths also take medicines that have a high risk of hypoglycemia. These individuals may benefit from a less-intense glucose control regimen to increase their safety. The study did not examine whether and how often these veterans had episodes hypoglycemia or their medication doses; instead, it focused solely on the risk factors for hypoglycemia.
Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia, by Thorpe and colleagues. Diabetes Care 2015;38:588-595. https://doi.org/10.2337/dc14-0599