Hypoglycaemic episodes and risk of dementia in diabetes mellitus: 7‐year follow‐up study

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Abstract
Objective: We investigated the risk of dementia in patients with type 2 diabetes with or without prior hypoglycaemic episodes.Subjects and Setting: One million subjects randomly selected from the National Health Insurance Research Database, Taiwan.Results: A total of 15 404 diabetic subjects without prior dementia and a mean age of 64.2 years were enrolled in the study. About 2% (n = 289) of participants had at least one episode of hypoglycaemia in a 3‐year period; these subjects were older and more likely to be women and also had higher rates of insulin use and comorbidities compared to those without hypoglycaemia. During a total of 7 years of follow‐up (mean and median follow‐up, 3.8 and 4.8 years, respectively), 1106 patients with diabetes (7.2%) developed dementia. The incidence rate of dementia was higher in diabetic subjects with [29.9 per 1000 person‐years (95% CI 22.1–39.2)] compared to those without [11.1 per 1000 person‐years (95% CI 10.3–11.8)] hypoglycaemic episodes. The crude rate ratio (RR) and age‐ and gender‐adjusted RR values for dementia were 2.76 (95% CI 2.06–3.70, P < 0.001) and 1.60 (95% CI 1.19–2.14, P = 0.002), respectively, in diabetic subjects with hypoglycaemia compared to those without hypoglycaemia. Results of Cox proportional hazards analysis revealed that hypoglycaemia, older age, female gender and insulin use were independent predictors of dementia.Conclusion: Adult diabetic patients with prior hypoglycaemia had a significantly increased risk of dementia. The influence of hypoglycaemic episodes on brain function warrants further investigation.
Funding Information
  • Taichung Veterans General Hospital (TCVGH-1013001C, TCVGH-1013002D, TCVGH-1017303B)
  • National Science Council (NSC-98-2314-B075A-002-MY3)

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