Abstract
BackgroundPatients with type 2 diabetes have an increased risk of cognitive impairment which can lead to impaired diabetes self-management and an increased risk of diabetes-related complications. Routine screening for cognitive impairment in elderly patients with type 2 diabetes is therefore increasingly advocated. The aim of this study is to investigate whether people with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often than patients not suspected of cognitive impairment.MethodsPeople with type 2 diabetes ≥ 70 years were screened for cognitive impairment in primary care. Diagnoses in screen positives were established at a memory clinic. Information about acute health care use was collected for 2 years prior to and 2 years after screening and compared to screen negatives.Results154 participants (38% female, mean age 76.7 ± 5.2 years, diabetes duration 8.7 ± 8.2 years) were included, 37 patients with cognitive impairment, 117 screen negatives. A higher percentage of participants with cognitive impairment compared to screen negative patients used acute health care services; this difference was significant for general practitioner’s out of hours services (56% versus 34% used this service over 4 years, p = 0.02). The mean number of acute health care visits was also higher in those with cognitive impairment than in screen negatives (2.2 ± 2.8 versus 1.4 ± 2.2 visits in 4 years, p < 0.05; 1.4 ± 2.2 versus 0.7 ± 1.5 visits in 2 years after screening, p = 0.03). Factors that could have played a role in this increased risk of acute health care services use were a low educational level, the presence of depressive symptoms (CES-D score ≥ 16), self-reported problems in self-care and self-reported problems in usual activities.ConclusionsPeople with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often.
Highlights
Patients with type 2 diabetes have an increased risk of cognitive impairment which can lead to impaired diabetes self-management and an increased risk of diabetes-related complications
To explore whether other factors than cognitive impairment could explain between group differences, we looked whether the use of acute health care services differed between groups that were stratified based on baseline characteristics with an unequal distribution between the groups
Of the remaining screen positives, 12 were not willing to attend the memory clinic and 56 had no cognitive impairment compatible with mild cognitive impairment (MCI) or dementia criteria; these patients were not included in the current analysis
Summary
Patients with type 2 diabetes have an increased risk of cognitive impairment which can lead to impaired diabetes self-management and an increased risk of diabetes-related complications. Routine screening for cognitive impairment in elderly patients with type 2 diabetes is increasingly advocated. Since cognitive impairment often remains unrecognized [10,11,12], routine screening for cognitive impairment in elderly patients with type 2 diabetes is increasingly advocated [9]. The argument is that routine screening may identify patients with cognitive impairment who might benefit from a personalized intervention It is unknown how often people with type 2 diabetes and cognitive impairment identified through screening (screen-detected cognitive impairment) experience acute health problems (e.g. problems that require the use of acute health care services or falls) and if this is more often than patients without cognitive impairment
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