Diabetes Metab J.  2020 Feb;44(1):125-133. 10.4093/dmj.2018.0260.

Hypoglycemia and Dementia Risk in Older Patients with Type 2 Diabetes Mellitus: A Propensity-Score Matched Analysis of a Population-Based Cohort Study

Affiliations
  • 1Department of Medical Sciences, Ajou University Graduate School, Suwon, Korea.
  • 2Ministry of Health and Welfare, Gyeonggi Provincial Government, Suwon, Korea.
  • 3Department of Neurology, Yeongwolgun Public Health Center, Yeongwol, Korea.
  • 4Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
  • 5Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea. hsj@ajou.ac.kr

Abstract

BACKGROUND
Type 2 diabetes mellitus (T2DM) is associated with an increased risk for dementia. The effects of hypoglycemia on dementia are controversial. Thus, we evaluated whether hypoglycemia increases the risk for dementia in senior patients with T2DM.
METHODS
We used the Korean National Health Insurance Service Senior cohort, which includes >10% of the entire senior population of South Korea. In total, 5,966 patients who had ever experienced at least one episode of hypoglycemia were matched with those who had not, using propensity score matching. The risk of dementia was assessed through a survival analysis of matched pairs.
RESULTS
Patients with underlying hypoglycemic events had an increased risk for all-cause dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) compared with those who had not experienced a hypoglycemic event (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.166 to 1.349; P<0.001 for all-cause dementia; HR, 1.264; 95% CI, 1.162 to 1.375; P<0.001 for AD; HR, 1.286; 95% CI, 1.110 to 1.490; P<0.001 for VaD). According to number of hypoglycemic episodes, the HRs of dementia were 1.170, 1.201, and 1.358 in patients with one hypoglycemic episode, two or three episodes, and more than three episodes, respectively. In the subgroup analysis, hypoglycemia was associated with an increased risk for dementia in both sexes with or without T2DM microvascular or macrovascular complications.
CONCLUSION
Our findings suggest that patients with a history of hypoglycemia have a higher risk for dementia. This trend was similar for AD and VaD, the two most important subtypes of dementia.

Keyword

Dementia; Diabetes mellitus, type 2; Hypoglycemia

MeSH Terms

Cohort Studies*
Dementia*
Dementia, Vascular
Diabetes Mellitus, Type 2*
Humans
Hypoglycemia*
Korea
National Health Programs
Propensity Score
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