Severe Hypoglycemia Increases Risk of Dementia for Elders With Type 2 Diabetes
WASHINGTON, DC -- April 14, 2009 -- Having hypoglycaemic episodes that are severe enough to require hospitalisation are associated with a greater risk of dementia for older adults with type 2 diabetes, according to a study published in the April 15 issue of JAMA.
Rachel A. Whitmer, PhD, of Kaiser Permanente, Oakland, California, presented the findings of the study at a JAMA media briefing at the National Press Club in Washington, DC.
Dr. Whitmer and colleagues conducted a study to determine whether prior episodes of hypoglycaemia that required hospitalisation or emergency department (ED) visits are associated with an increased risk of dementia.
The study included 22 years (1980-2002) of follow-up for hypoglycaemic episodes and more than 4 years (starting in 2003) of follow-up for diagnosis of dementia, and included 16,667 patients with type 2 diabetes (mean age, 65 years).
The researchers found that a total of 1,822 patients (11%) had a diagnosis of dementia and 1,465 patients (8.8%) had at least 1 episode of hypoglycaemia; 250 patients had both dementia and at least 1 episode of hypoglycaemia (16.95%).
Age-adjusted incidence rates of dementia by frequency of hypoglycaemic episodes were significantly elevated for patients with at least 1 episode compared with patients with no episodes.
"Specifically, we observed a 2.39% increase in absolute risk of dementia per year of follow-up for patients with history of hypoglycaemia, compared with patients without a history. Although this 1-year absolute risk difference is modest, the cumulative effects would be sizeable," the authors wrote.
Compared with patients with no hypoglycaemia, patients with single or multiple episodes had a graded increase in risk of dementia. Patients with 1 hypoglycaemic episode had a 26% increased risk; 2 episodes, an 80% increased risk; and 3 or more hypoglycaemic episodes were associated with nearly double the risk for dementia.
"Our results suggest that hypoglycaemic episodes severe enough to require hospitalisation or an ED visit are associated with increased risk of dementia, particularly for patients who have a history of multiple episodes," the authors wrote.
"A large body of evidence suggests that individuals with diabetes are at an increased risk of dementia, yet exact mechanisms are not known; our study suggests a potentially modifiable mechanism. Pharmacologically induced severe hypoglycemia may be associated with neurological consequences in an older population already susceptible to dementia. More scientific studies examining hypoglycemia and cognitive performance and brain-imaging sequelae in populations of older patients with type 2 diabetes are needed."
Increased mortality associated with nocturia
Patients, physicians should be vigilant about underlying causes of nighttime urination
Patients suffering from nocturia, the need to urinate at least twice during the night, may have a significantly increased risk for mortality. Researchers presented a study at the 104th
Annual Scientific Meeting of the American Urological Association (AUA) showing that there was a significantly increased mortality rate in elderly patients living in a Japanese assisted-living facility who suffered from nocturia relative to other residents.
Researchers conducted a comprehensive geriatric assessment of 788 residents 70 years old or older to determine incidence of nocturia. Using data from a national health insurance system, researchers assessed differences in survival stratified by presence or absence of nocturia over three years. Researchers adjusted the models to control for age, sex, BMI, diabetes, hypertension, history of coronary heart disease, nephropathy, alcohol consumption, and use of tranquilizers, hypnotics or diuretics.
"Nighttime urination is not necessarily just a matter of getting older. Patients should talk to their doctor about what may be causing this," said Anthony Y. Smith, MD, an AUA spokesman. "There may be a very serious yet treatable condition involved."
Study finds homicidal poisoning rising, more likely in infants and elderly
Homicidal poisonings are rare but on the rise—and infants are the most common victims— according to a new University of Georgia study that aims to raise awareness of this often overlooked crime.
Greene Shepherd, clinical professor in the UGA College of Pharmacy, and recent graduate Brian Ferslew examined seven years of recent federal mortality data and identified 523 deaths due to homicidal poisoning—a figure that corresponds to a rate of 0.26 poisonings per million people. The study found that although poisonings account for less than one percent of all homicides, they appear to be on the rise. The study documented a low of 0.20 cases per million in 2000 and a high of 0.35 in 2004. In 2005, the last year for which data is available, t he rate was 0.3 per million people.
"Homicidal poisoning is rare relative to a lot of other causes of death, but the numbers are t rending higher," said Shepherd, whose results appear in the May issue of the journal Clinical Toxicology. "We may never know the true incidence because some cases undoubtedly evade detection and classification."
Shepherd is a former poison control center director who had heard several anecdotal accounts of homicidal poisonings but found very little data on their incidence. Because such data is a critical starting point for efforts to reduce the risk of poisonings, he and Ferslew began combing through data compiled by the National Center for Health Statistics.
While books and television dramas often portray homicidal poisoning as a premeditated crime committed against adults, the researchers found that infants are the most common victims. Children less than one year old are approximately nine times more likely to be victims than the general population, the study found. Shepherd said that rather than being premeditated acts, the majority of these poisonings are likely negligent homicides committed by parents or caretakers.
"Anyone who has been a new parent knows about the long hours and the stress of an inconsolable child ," Shepherd says. "In some cases people make bad decisions and try to sedate their children with medication or alcohol. I think there's a role for pharmacists and other health care workers to better educate new parents about the inappropriateness of sedating newborns."
Further analysis by race found that African-American infants —who are 21 times more likely to be victims than the general population— are most at risk. Shepherd said this increased risk among African Americans is "a tragic result of socioeconomic status," as stressful situations and poor coping skills are more common in young parents lacking family support and economic stability.
The study found that older adults also had a significantly higher rate of poisoning than the general population. Older adults who require institutional or home care are particularly susceptible to abuse, Shepherd said, and are at risk of being administered excessive doses of sedatives or other medications.
The study also found that drugs, medications and other biological substances accounted for 65 percent of the poisonings during the 1999 to 2005 study period, while assault by gasses and vapor accounted for 28 percent of poisonings. The remaining seven percent of assaults involved other chemicals, corrosive substances or pesticides.
"Though rare, these crimes do happen," Shepherd said. "Now that we've identified at-risk populations, we have the potential to raise awareness and possibly save lives."