Abbatecola Angela Marie, Bo Mario, Barbagallo Mario, Incalzi Raffaele Antonelli, Pilotto Alberto, Bellelli Giuseppe, Maggi Stefania, Paolisso Giuseppe
Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy.
Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
J Am Med Dir Assoc. 2015 Apr;16(4):349.e7-12. doi: 10.1016/j.jamda.2014.12.014. Epub 2015 Feb 7.
Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status.
Cross-sectional observational study.
A total of 150 nursing homes across Italy.
A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120).
Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents.
Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia.
In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer.
严重低血糖与老年2型糖尿病患者的认知功能下降和痴呆症相关。抗糖尿病治疗对痴呆症患者严重低血糖的作用尚不清楚。本研究旨在确定严重低血糖事件的发生率，并根据痴呆状态，调查大量糖尿病疗养院患者中严重低血糖与特定抗糖尿病治疗（口服药物类别和胰岛素类似物类型）之间的关联。
横断面观察性研究。
意大利各地共150家疗养院。
共2258例2型糖尿病患者（痴呆症患者1138例，无痴呆症患者1120例）。
疗养院入院前的痴呆症诊断。收集了有关功能状态、血糖控制、抗糖尿病治疗、合并症以及生化和临床测量的数据。以严重低血糖为因变量的逻辑回归模型用于检验与抗糖尿病药物的关联。
患者的平均年龄（标准差）为82（8）岁，体重指数（BMI）为25.4（4.8），空腹血糖（FPG）为7.5（3.0）mmol/L，餐后血糖（PPG）为10.3（3.6）mmol/L，糖化血红蛋白（HbA1c）为7.1%（54 mmol/L），日常生活活动（ADL）受损评分为3.7（2.1）。与无痴呆症患者（8%）相比，痴呆症患者中严重低血糖更为普遍（18%）。与无痴呆症患者相比，痴呆症患者年龄更大，ADL受损更严重，合并症更多，FPG更低，PPG更高。对痴呆症患者的校正逻辑回归模型显示，速效和长效胰岛素类似物与较低的比值比（OR）相关（分别为OR 0.333；95%置信区间[CI]0.184 - 0.602；OR 0.248，95%CI 0.070 - 0.882），而磺脲类药物以及二甲双胍 + 磺脲类药物联合使用与严重低血糖的OR增加相关（分别为OR 8.805，95%CI 4.260 - 18. .201；OR 6.639；95%CI 3.273 - 14.710）。在无痴呆症患者中未发现相关性。
在老年疗养院2型糖尿病患者中，痴呆症患者的严重低血糖显著更高。我们的研究结果表明，应谨慎使用磺脲类药物。而速效和长效胰岛素类似物似乎更安全。
