Abstract
Background: The goals of glycemic control based on their cognitive function are recommended for elderly patients. However, the recommendation of the glycemic control is different among the associations. That is, IDF and the Japan Diabetes Society set lower limit of HbA1c and ADA doesn’t. Moreover, there is not a clear course of treatments for elderly diabetics with dementia. Methods: We retrospectively assessed the correlation between blood glucose management and cognitive function of 616 outpatients aged 65 years or older who visited our hospital from March 14 to April 30, 2017. HbA1c, blood glucose level, and therapeutic agents were obtained from medical records. Cognitive function was evaluated with Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21), which the Japan Diabetes Society and the Japan Geriatrics Society approve. The patients were allocated to three categories based on cognitive function (normal function: I, mild dementia: II, moderate and severe dementia: III), and two categories based on therapeutic agents (not using insulin, SU, or glinide: A, using insulin, SU, and/or glinide: B). Results: The numbers of the patients in IA, IB, IIA, IIB, IIIA, and IIIB were 138, 362, 11, 66, 7, and 32, respectively. The proportion of the patients whose HbA1c were below the lower limit was significantly higher in IIIB than that in IIB (43.8% vs. 19.7%, p <0.05). The proportion of the patients who underwent hypoglycemia (blood glucose <70 mg/dl) within recent 1 month was significantly higher in IIIB than that in IIB (28.1% vs. 18.2%, p <0.05). In IIIB, there were more hypoglycemic events in the patients whose HbA1c were above the lower limit than the patients whose HbA1c were below the lower limit (38.9% vs. 14.3%, p <0.05). Conclusions: This study shows that progression of cognitive impairment increases the risk of hypoglycemia. Moreover, this result suggests that the risk of hypoglycemia shouldn’t be evaluated only with HbA1c for elderly patients with dementia. Disclosure T. Yasuda: None. S. Muro: None. H. Fujita: None. M. Fujimura: None. T. Hatoko: None. E. Mori: None. S. Yonemitsu: None.
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