The Relationship between All‐cause Dementia and Acute Diabetes Complications among American Indian and Alaska Native Peoples

Abstract

AbstractBackgroundAmerican Indian and Alaska Native people (AI/ANs) bear a disproportionate burden of diabetes. Growing evidence has shown significant associations between several acute diabetes complications and dementia among diabetes patients in the general population. However, little is known about these relationships among AI/ANs.MethodsThis cross‐sectional study extracted patient registration and health service utilization data from the Indian Health Service’s National Data Warehouse and related administrative databases. A total of 29,337 AI/AN adults with diabetes who were 45+ years old and used IHS or tribal health services during fiscal year 2013 were included. All‐cause dementia and acute diabetes complications were identified using ICD‐9 diagnostic codes in the utilization data. Negative binomial regression models were used to evaluate the associations of interest after adjusting for potential confounders.ResultsNearly 3% (n = 843) of AI/AN diabetes patients had a dementia diagnosis. Among AI/ANs with diabetes, similar proportions of patients had a history of hospitalization or ED visits for hypoglycemia only (3.6%) or hyperglycemia only (4.1%). About 0.8% had both types of acute diabetes complications. As shown in Fig1, after controlling for demographics, health care coverage, and comorbidities, dementia diagnosis was associated with 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50‐2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11‐2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53‐2.41). Dementia was not significantly associated with diabetic ketoacidosis (DKA) in the adjusted model (IRR = 1.82, 95% CI:0.83‐4.01). Further adjustments on clinical measurements and medications did not substantially change the estimated IRRs for hypoglycemia and hyperglycemia.ConclusionsAI/AN diabetes patients with dementia suffered from considerably higher rates of severe hypoglycemia and hyperglycemia than their counterparts without dementia. Clinical management of patients with comorbid diabetes and dementia is particularly challenging and requires individualized treatment approaches.