Premium
Dementia diagnosis affects pharmacological management of diabetes mellitus: A matched analysis of ∼20,000 patients from the Swedish registries
Author(s) -
Secnik Juraj,
Xu Hong,
Schwertner Emilia,
Hammar Niklas,
Alvarsson Michael,
Winblad Bengt,
Eriksdotter Maria,
GarciaPtacek Sara,
Religa Dorota
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039772
Subject(s) - dementia , medicine , diabetes mellitus , population , cohort , metformin , comorbidity , type 2 diabetes mellitus , sulfonylurea , cohort study , insulin , endocrinology , disease , environmental health
Background Currently, there is no evidence‐based approach to treatment of diabetes mellitus (DM) when dementia is present. To reflect current clinical practice, we aimed to determine the differences in antidiabetic drug usage among DM patients with and without dementia. Method In this open‐cohort study we used five national Swedish registers to extract patients with DM & dementia and compared them to patients with DM who were dementia‐free. Overall, 10,470 DM & dementia patients registered to the Swedish Dementia Registry (until October 2018) were propensity‐score matched to 10,470 DM & dementia‐free controls originating from the Total Population Register. Information on comorbidities, antidiabetic and other medication and mortality originated from the Patient Register, Prescribed Drug Register and Cause of Death Register, respectively. Matching characteristics included index date (date of dementia diagnosis), age, sex, comorbidity score, education, DM type (excluding type 1 DM), DM duration and cardiovascular, psychotropic and dementia medication. Competing‐risk regression models (death as competing risk) were used to evaluate whether dementia status may alter the probability of antidiabetic drug usage defined using the date of first dispensation after dementia diagnosis (or index date) in patients without history of usage. Medications of interest were insulin, metformin, sulfonylurea derivates (SU), thiazolidinediones and more modern medication like dipeptidyl‐peptidase‐4 inhibitors (DPP‐4i), glucagon‐like peptid‐1 agonists (GLP‐1a) and sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i). We also assessed the likelihood of treatment with other antidiabetic drugs in addition to metformin as a proxy for treatment intensification. Result The dementia and DM group was significantly more likely to be treated with insulin (sHR 1.31 [95% CI 1.21‐1.43]) and less likely to receive DPP‐4i (0.79 [0.72‐0.88]), GLP‐1a (0.50 [0.40‐0.63]) and SGLT‐2i (0.42 [0.34‐0.52]). Dementia patients were also more likely to receive further medication in addition to metformin (1.08 [1.01‐1.15]). Conclusions In comparison to dementia‐free controls, dementia patients were less likely to receive modern antidiabetic drugs, with simultaneous higher likelihood of being prescribed insulin.