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Low Blood Sugar Events Increase Dementia Risk in Elderly Patients With Type 2 Diabetes, Kaiser Permanente Study Finds
Date:4/14/2009

ia after 2003. Those with two episodes had a 115 percent increased risk, and those with three or more episodes had a 160 percent increased risk of dementia. Adjustments were made for age, body mass index, race, education, gender, and duration of diabetes. The effect remained after further adjustments for hypertension, stroke, cardiovascular disease, end-stage renal disease, glycosylated hemoglobin levels, and treatment for diabetes.

Researchers were concerned that cognitive impairment from early dementia could be contributing to an increased likelihood of having a hypoglycemic episode. To address this, the researchers introduced various "lag" periods between the occurrence of hypoglycemic episodes and the initial diagnosis of dementia. In effect, researchers considered only hypoglycemic episodes in midlife (at an age where dementia is virtually impossible). Even when only considering hypoglycemic episodes in midlife (mean age 52), there remained a significant association between hypoglycemic episodes occurring before 1985 and onset of dementia in 2003 or later. Compared to those with no hypoglycemic episodes, those with one or more episode had a 32 percent greater risk of dementia (adjusted for age, body mass index, education, gender, duration of diabetes, co-morbidities, glycosylated hemoglobin and treatment for diabetes).

"Our findings suggest that pursuit of 'tight' glycemic control (i.e. to hemoglobin A1c levels less than 7 percent) may be inadvisable in older patients with type 2 diabetes if required treatment is causing hypoglycemia," explained Joe Selby, MD, MPH, a co-author on this study and the director of the Kaiser Permanente Division of Research.

Funded by the National Institutes of Health, this study adds additional information to a growing evidence base on this topic. Three recent trials -- the ACCORD Study, the ADVANCE Study and the VADT Study -- have shown clearly that tight glycemic control do
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SOURCE Kaiser Permanente
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