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The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study
Author(s) -
Mattishent Katharina,
Richardson Kathryn,
Dhatariya Ketan,
Savva George M.,
Fox Chris,
Loke Yoon K.
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13769
Subject(s) - medicine , dementia , hazard ratio , adverse effect , cohort , cohort study , proportional hazards model , diabetes mellitus , retrospective cohort study , randomized controlled trial , pediatrics , confidence interval , endocrinology , disease
Aims Older individuals with diabetes are susceptible to harm as the result of hypoglycaemia; however, the consequences of hypoglycaemia in older individuals with dementia are not known. We aimed to test the association between hypoglycaemia and serious adverse events in older patients with diabetes and dementia, and whether the consequences of hypoglycaemia were affected by the presence of dementia. Materials and methods This was a cohort study using the Clinical Practice Research Datalink in England (1997‐2016). We selected participants, intervention (exposure) and follow‐up to mirror two hypothetical target randomized controlled trials. The exposure of target trial 1 was hypoglycaemia in patients with dementia. Target trial 2 examined adverse effects of hypoglycaemia according to dementia status. We used Cox proportional hazard regression to estimate adjusted hazard ratios (aHR) for falls, fractures, cardiovascular events and mortality. Results In target trial 1, hypoglycaemia was associated with increased risk during a 12‐month follow‐up period for falls and fractures (aHR, 1.94 [95% CI, 1.67‐2.24]), for cardiovascular events (aHR, 2.00 [95% CI, 1.61‐2.48]) and for mortality (aHR, 2.36 [95% CI, 2.09‐2.67]). In target trial 2, the presence of dementia was associated with increased risk of adverse events, following hypoglycaemia, during a 12‐month follow‐up period for falls and factures (aHR, 1.72 [95% CI, 1.51‐1.96]) and for mortality (aHR, 1.27 [95% CI, 1.15‐1.41]), but dementia had no effect on cardiovascular events (aHR, 1.14 [95% CI, 0.95 to 1.36]). Conclusions Hypoglycaemia is associated with early increased risk of serious adverse events in older individuals with diabetes and dementia.