Severe hypoglycaemia and cognitive impairment in older patients with diabetes: The Fremantle Diabetes Study
Open accessAbstract
Aims/hypothesis The aim was to investigate the relationship between severe hypoglycaemia and cognitive impairment in older patients with diabetes.Methods A sample of 302 diabetic patients aged >/=70 years was assessed for dementia or cognitive impairment without dementia in 2001-2002 and a subsample of non-demented patients (n = 205) was followed to assess cognitive decline. A history of severe hypoglycaemia was determined from self-reports, physician assessments and records of health service use for hypoglycaemia (HSH). Prospective HSH was determined up to 2006. Data analysis, including multiple logistic and Cox regression models, was used to determine whether: (1) there were cross-sectional associations between hypoglycaemia and cognitive status, (2) historical hypoglycaemia predicted cognitive decline, and (3) baseline cognitive status predicted subsequent HSH.Results There were significant cross-sectional associations between both cognitive impairment and dementia and hypoglycaemia. Independent risk factors for future HSH included dementia (hazard ratio 3.00, 95% CI 1.06-8.48) and inability to self-manage medications (hazard ratio 4.17, 95% CI 1.43-12.13). However, there were no significant associations between historical hypoglycaemia, incident HSH and cognitive decline.Conclusions/interpretation Dementia is an important risk factor for hypoglycaemia requiring health service utilisation. We found no evidence that hypoglycaemia contributes to cognitive impairment in older patients with diabetes.
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The person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors.
“The person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors (19,56,57)”
From Hypoglycemia (2018) · cites this paper as [56]
The Abstract reports that dementia predicted future hypoglycaemia requiring health-service use in patients with diabetes aged 70 or older, and that inability to self-manage medications was also a risk factor. The Introduction suggests medication errors as a possible mechanism. The claim is broader than the prospective finding: the paper establishes that risk for dementia, not cognitive disorders generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredProspective studies have not found an association between intensive insulin therapy and cognitive function, or between severe hypoglycemia and future cognitive function.
“Prospective studies have not found an association between intensive insulin therapy and cognitive function (58)(59)(60), or between severe hypoglycemia and future cognitive function (56,57).”
From Hypoglycemia (2018) · cites this paper as [56]
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References 31 · Cited by 202
- Authors
- Bruce, D. G., Davis, W. A., Casey, G. P., Clarnette, R. M., Brown, S. G. A., Jacobs, I. G., Almeida, O. P., & Davis, T. M. E.
- Affiliations
- The University of Western Australia (AU)
- Fremantle Hospital (AU)
- Corresponding author
- Bruce, D. G.
- Venue
- Diabetologia
- Published
- 2009-07-03
- Volume
- 52
- Issue
- 9
- Pages
- 1808-1815
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1992934050
- Cited by
- 202
- References
- 31
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 11 · 2019: 18 · 2018: 26 · 2017: 14 · 2016: 15 · 2015: 15 · 2014: 11 · 2013: 21 · 2012: 12
- FWCI
- 9.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- Sanofi
- Diabetes Australia Research Trust
- Diabetes Australia
- Medical Research Council
- National Health and Medical Research Council (139139)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- severe hypoglycemia, cognitive impairment, dementia, cognitive decline, older adults, diabetes mellitus, medication self-management, health care utilization, Fremantle Diabetes Study
- MeSH terms
- Aged, Aged, 80 and over, Cognition Disorders, Dementia, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Mental Status Schedule, Predictive Value of Tests, Probability, Surveys and Questionnaires, Regression Analysis, Sulfonylurea Compounds, Western Australia, Prevalence, Survival Rate, Patient Selection, Diabetes Complications
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