Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy
Objectives To examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment. Design Cross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2011-12, Vol.59 (12), p.2263-2272 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | Feil, Denise G. Rajan, Mangala Soroka, Orysya Tseng, Chin-Lin Miller, Donald R. Pogach, Leonard M. |
| description | Objectives
To examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment.
Design
Cross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age, antiglycemic medications, and glycosylated hemoglobin (Hba1c) level.
Setting
Research database with linked clinical, laboratory, pharmacy, and International Classification of Diseases, Ninth Revision, Clinical Modification, codes.
Participants
Four hundred ninety‐seven thousand nine hundred veterans aged 65 and older with diabetes mellitus who obtained services from the Department of Veterans Affairs in fiscal years (FYs) 2002 and 2003.
Measurements
Hypoglycemia, the outcome variable, was identified from outpatient visits, emergency department and inpatient admission codes in FY2003. Independent variables (FY2002–03) included dementia and cognitive impairment, comorbid conditions, extended care and nursing home stays, demographics, antiglycemic medication, and HbA1c levels.
Results
Prevalence of combined dementia and cognitive impairment was 13.1% for individuals aged 65 to 74 and 24.2% for those aged 75 and older. Mean HbA1c levels were 7.0 ± 1.3% for all participants and 6.9 ± 1.3% for those with dementia. The proportion of participants taking insulin was higher in those with dementia or cognitive impairment (30%) than in those with neither condition (24%). Of all participants taking insulin, more with dementia (26.5%) and cognitive impairment (19.5%) were hypoglycemic than of those with neither condition (14.4%). For all participants, unadjusted odds ratios (ORs) for hypoglycemia were 2.42 (95% confidence interval (CI) = 2.36–2.48) for dementia and 1.72 (95% CI = 1.65–1.79) for cognitive impairment; adjusted ORs were 1.58 (95% CI = 1.53–1.62) for dementia and 1.13 (95% CI = 1.08–1.18) for cognitive impairment.
Conclusion
Diabetes mellitus was managed more intensively in older veterans with dementia and cognitive impairment, and dementia and cognitive impairment were independently associated with greater risk of hypoglycemia. |
| doi_str_mv | 10.1111/j.1532-5415.2011.03726.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_920791153</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>920791153</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4956-9dc74c43ee9473535dc9aa1f1c78ed894055deee1175ec127e11419e29bbf0203</originalsourceid><addsrcrecordid>eNqNkV1v0zAUhi0EYmXwF5CFhLhK8Uccx0hcTAW6ocGm8iXtxnKdk-EuiYudsubf46ylSNyAb3yk93mPzjkvQpiSKU3v5WpKBWeZyKmYMkLplHDJiun2HpochPtoQghhWVnQ_Ag9inFFCGWkLB-iI8aoIFQUExQXLt5gX-PTYe2vm8FC6wx2Hb5oKgj4K_QQTBfxreu_4zfQQtcn3XQVnvnrzvXuJ-Czdm1cGKVXY904a3rnk6n2AV8GY3tn4c5z6ZM4PEYPatNEeLL_j9GXd28_z06z84v52ezkPLO5EkWmKitzm3MAlUsuuKisMobW1MoSqlLlRIgKACiVAixlMlU5VcDUclkTRvgxerHruw7-xwZir1sXLTSN6cBvolaMSEXTwf5NUlbwkkqWyGd_kSu_CV1aY4SYKmUxtit3kA0-xgC1XgfXmjBoSvQYoF7pMSc95qTHAPVdgHqbrE_3_TfLFqqD8XdiCXi-B0y0pqlTOtbFP5zg6Xh8nOH1jrt1DQz_PYB-P_80Vsmf7fwu9rA9-E240YXkUuhvH-f6apFzJT5c6QX_BVc-xKU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>912298763</pqid></control><display><type>article</type><title>Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Feil, Denise G. ; Rajan, Mangala ; Soroka, Orysya ; Tseng, Chin-Lin ; Miller, Donald R. ; Pogach, Leonard M.</creator><creatorcontrib>Feil, Denise G. ; Rajan, Mangala ; Soroka, Orysya ; Tseng, Chin-Lin ; Miller, Donald R. ; Pogach, Leonard M.</creatorcontrib><description>Objectives
To examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment.
Design
Cross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age, antiglycemic medications, and glycosylated hemoglobin (Hba1c) level.
Setting
Research database with linked clinical, laboratory, pharmacy, and International Classification of Diseases, Ninth Revision, Clinical Modification, codes.
Participants
Four hundred ninety‐seven thousand nine hundred veterans aged 65 and older with diabetes mellitus who obtained services from the Department of Veterans Affairs in fiscal years (FYs) 2002 and 2003.
Measurements
Hypoglycemia, the outcome variable, was identified from outpatient visits, emergency department and inpatient admission codes in FY2003. Independent variables (FY2002–03) included dementia and cognitive impairment, comorbid conditions, extended care and nursing home stays, demographics, antiglycemic medication, and HbA1c levels.
Results
Prevalence of combined dementia and cognitive impairment was 13.1% for individuals aged 65 to 74 and 24.2% for those aged 75 and older. Mean HbA1c levels were 7.0 ± 1.3% for all participants and 6.9 ± 1.3% for those with dementia. The proportion of participants taking insulin was higher in those with dementia or cognitive impairment (30%) than in those with neither condition (24%). Of all participants taking insulin, more with dementia (26.5%) and cognitive impairment (19.5%) were hypoglycemic than of those with neither condition (14.4%). For all participants, unadjusted odds ratios (ORs) for hypoglycemia were 2.42 (95% confidence interval (CI) = 2.36–2.48) for dementia and 1.72 (95% CI = 1.65–1.79) for cognitive impairment; adjusted ORs were 1.58 (95% CI = 1.53–1.62) for dementia and 1.13 (95% CI = 1.08–1.18) for cognitive impairment.
Conclusion
Diabetes mellitus was managed more intensively in older veterans with dementia and cognitive impairment, and dementia and cognitive impairment were independently associated with greater risk of hypoglycemia.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2011.03726.x</identifier><identifier>PMID: 22150156</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Hoboken, NJ: Blackwell Publishing Ltd</publisher><subject>Age ; Aged ; Biological and medical sciences ; Classification ; Cognition & reasoning ; Cognition Disorders - complications ; Cognitive ability ; cognitive impairment ; Cross-Sectional Studies ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Dementia ; Dementia - complications ; Dementia disorders ; Demography ; Diabetes ; Diabetes Complications - complications ; Diabetes Complications - drug therapy ; Diabetes mellitus ; Drugs ; emergency medical services ; Female ; General aspects ; Geriatrics ; glycemic control ; Hemoglobin ; Humans ; Hypoglycemia ; Hypoglycemia - epidemiology ; Hypoglycemia - etiology ; Insulin ; Male ; Medical sciences ; Miscellaneous ; Neurology ; Nursing ; Older people ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Factors ; Veterans</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2011-12, Vol.59 (12), p.2263-2272</ispartof><rights>2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society</rights><rights>2015 INIST-CNRS</rights><rights>2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.</rights><rights>2011 American Geriatrics Society and Wiley Periodicals, Inc</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4956-9dc74c43ee9473535dc9aa1f1c78ed894055deee1175ec127e11419e29bbf0203</citedby><cites>FETCH-LOGICAL-c4956-9dc74c43ee9473535dc9aa1f1c78ed894055deee1175ec127e11419e29bbf0203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2011.03726.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2011.03726.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25349533$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22150156$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feil, Denise G.</creatorcontrib><creatorcontrib>Rajan, Mangala</creatorcontrib><creatorcontrib>Soroka, Orysya</creatorcontrib><creatorcontrib>Tseng, Chin-Lin</creatorcontrib><creatorcontrib>Miller, Donald R.</creatorcontrib><creatorcontrib>Pogach, Leonard M.</creatorcontrib><title>Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives
To examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment.
Design
Cross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age, antiglycemic medications, and glycosylated hemoglobin (Hba1c) level.
Setting
Research database with linked clinical, laboratory, pharmacy, and International Classification of Diseases, Ninth Revision, Clinical Modification, codes.
Participants
Four hundred ninety‐seven thousand nine hundred veterans aged 65 and older with diabetes mellitus who obtained services from the Department of Veterans Affairs in fiscal years (FYs) 2002 and 2003.
Measurements
Hypoglycemia, the outcome variable, was identified from outpatient visits, emergency department and inpatient admission codes in FY2003. Independent variables (FY2002–03) included dementia and cognitive impairment, comorbid conditions, extended care and nursing home stays, demographics, antiglycemic medication, and HbA1c levels.
Results
Prevalence of combined dementia and cognitive impairment was 13.1% for individuals aged 65 to 74 and 24.2% for those aged 75 and older. Mean HbA1c levels were 7.0 ± 1.3% for all participants and 6.9 ± 1.3% for those with dementia. The proportion of participants taking insulin was higher in those with dementia or cognitive impairment (30%) than in those with neither condition (24%). Of all participants taking insulin, more with dementia (26.5%) and cognitive impairment (19.5%) were hypoglycemic than of those with neither condition (14.4%). For all participants, unadjusted odds ratios (ORs) for hypoglycemia were 2.42 (95% confidence interval (CI) = 2.36–2.48) for dementia and 1.72 (95% CI = 1.65–1.79) for cognitive impairment; adjusted ORs were 1.58 (95% CI = 1.53–1.62) for dementia and 1.13 (95% CI = 1.08–1.18) for cognitive impairment.
Conclusion
Diabetes mellitus was managed more intensively in older veterans with dementia and cognitive impairment, and dementia and cognitive impairment were independently associated with greater risk of hypoglycemia.</description><subject>Age</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Classification</subject><subject>Cognition & reasoning</subject><subject>Cognition Disorders - complications</subject><subject>Cognitive ability</subject><subject>cognitive impairment</subject><subject>Cross-Sectional Studies</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Dementia</subject><subject>Dementia - complications</subject><subject>Dementia disorders</subject><subject>Demography</subject><subject>Diabetes</subject><subject>Diabetes Complications - complications</subject><subject>Diabetes Complications - drug therapy</subject><subject>Diabetes mellitus</subject><subject>Drugs</subject><subject>emergency medical services</subject><subject>Female</subject><subject>General aspects</subject><subject>Geriatrics</subject><subject>glycemic control</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - epidemiology</subject><subject>Hypoglycemia - etiology</subject><subject>Insulin</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Neurology</subject><subject>Nursing</subject><subject>Older people</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Risk Factors</subject><subject>Veterans</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV1v0zAUhi0EYmXwF5CFhLhK8Uccx0hcTAW6ocGm8iXtxnKdk-EuiYudsubf46ylSNyAb3yk93mPzjkvQpiSKU3v5WpKBWeZyKmYMkLplHDJiun2HpochPtoQghhWVnQ_Ag9inFFCGWkLB-iI8aoIFQUExQXLt5gX-PTYe2vm8FC6wx2Hb5oKgj4K_QQTBfxreu_4zfQQtcn3XQVnvnrzvXuJ-Czdm1cGKVXY904a3rnk6n2AV8GY3tn4c5z6ZM4PEYPatNEeLL_j9GXd28_z06z84v52ezkPLO5EkWmKitzm3MAlUsuuKisMobW1MoSqlLlRIgKACiVAixlMlU5VcDUclkTRvgxerHruw7-xwZir1sXLTSN6cBvolaMSEXTwf5NUlbwkkqWyGd_kSu_CV1aY4SYKmUxtit3kA0-xgC1XgfXmjBoSvQYoF7pMSc95qTHAPVdgHqbrE_3_TfLFqqD8XdiCXi-B0y0pqlTOtbFP5zg6Xh8nOH1jrt1DQz_PYB-P_80Vsmf7fwu9rA9-E240YXkUuhvH-f6apFzJT5c6QX_BVc-xKU</recordid><startdate>201112</startdate><enddate>201112</enddate><creator>Feil, Denise G.</creator><creator>Rajan, Mangala</creator><creator>Soroka, Orysya</creator><creator>Tseng, Chin-Lin</creator><creator>Miller, Donald R.</creator><creator>Pogach, Leonard M.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>201112</creationdate><title>Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy</title><author>Feil, Denise G. ; Rajan, Mangala ; Soroka, Orysya ; Tseng, Chin-Lin ; Miller, Donald R. ; Pogach, Leonard M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4956-9dc74c43ee9473535dc9aa1f1c78ed894055deee1175ec127e11419e29bbf0203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Age</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Classification</topic><topic>Cognition & reasoning</topic><topic>Cognition Disorders - complications</topic><topic>Cognitive ability</topic><topic>cognitive impairment</topic><topic>Cross-Sectional Studies</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Dementia</topic><topic>Dementia - complications</topic><topic>Dementia disorders</topic><topic>Demography</topic><topic>Diabetes</topic><topic>Diabetes Complications - complications</topic><topic>Diabetes Complications - drug therapy</topic><topic>Diabetes mellitus</topic><topic>Drugs</topic><topic>emergency medical services</topic><topic>Female</topic><topic>General aspects</topic><topic>Geriatrics</topic><topic>glycemic control</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - epidemiology</topic><topic>Hypoglycemia - etiology</topic><topic>Insulin</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Neurology</topic><topic>Nursing</topic><topic>Older people</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Risk Factors</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feil, Denise G.</creatorcontrib><creatorcontrib>Rajan, Mangala</creatorcontrib><creatorcontrib>Soroka, Orysya</creatorcontrib><creatorcontrib>Tseng, Chin-Lin</creatorcontrib><creatorcontrib>Miller, Donald R.</creatorcontrib><creatorcontrib>Pogach, Leonard M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feil, Denise G.</au><au>Rajan, Mangala</au><au>Soroka, Orysya</au><au>Tseng, Chin-Lin</au><au>Miller, Donald R.</au><au>Pogach, Leonard M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2011-12</date><risdate>2011</risdate><volume>59</volume><issue>12</issue><spage>2263</spage><epage>2272</epage><pages>2263-2272</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives
To examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment.
Design
Cross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age, antiglycemic medications, and glycosylated hemoglobin (Hba1c) level.
Setting
Research database with linked clinical, laboratory, pharmacy, and International Classification of Diseases, Ninth Revision, Clinical Modification, codes.
Participants
Four hundred ninety‐seven thousand nine hundred veterans aged 65 and older with diabetes mellitus who obtained services from the Department of Veterans Affairs in fiscal years (FYs) 2002 and 2003.
Measurements
Hypoglycemia, the outcome variable, was identified from outpatient visits, emergency department and inpatient admission codes in FY2003. Independent variables (FY2002–03) included dementia and cognitive impairment, comorbid conditions, extended care and nursing home stays, demographics, antiglycemic medication, and HbA1c levels.
Results
Prevalence of combined dementia and cognitive impairment was 13.1% for individuals aged 65 to 74 and 24.2% for those aged 75 and older. Mean HbA1c levels were 7.0 ± 1.3% for all participants and 6.9 ± 1.3% for those with dementia. The proportion of participants taking insulin was higher in those with dementia or cognitive impairment (30%) than in those with neither condition (24%). Of all participants taking insulin, more with dementia (26.5%) and cognitive impairment (19.5%) were hypoglycemic than of those with neither condition (14.4%). For all participants, unadjusted odds ratios (ORs) for hypoglycemia were 2.42 (95% confidence interval (CI) = 2.36–2.48) for dementia and 1.72 (95% CI = 1.65–1.79) for cognitive impairment; adjusted ORs were 1.58 (95% CI = 1.53–1.62) for dementia and 1.13 (95% CI = 1.08–1.18) for cognitive impairment.
Conclusion
Diabetes mellitus was managed more intensively in older veterans with dementia and cognitive impairment, and dementia and cognitive impairment were independently associated with greater risk of hypoglycemia.</abstract><cop>Hoboken, NJ</cop><pub>Blackwell Publishing Ltd</pub><pmid>22150156</pmid><doi>10.1111/j.1532-5415.2011.03726.x</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2011-12, Vol.59 (12), p.2263-2272 |
| issn | 0002-8614 1532-5415 |
| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Age Aged Biological and medical sciences Classification Cognition & reasoning Cognition Disorders - complications Cognitive ability cognitive impairment Cross-Sectional Studies Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dementia Dementia - complications Dementia disorders Demography Diabetes Diabetes Complications - complications Diabetes Complications - drug therapy Diabetes mellitus Drugs emergency medical services Female General aspects Geriatrics glycemic control Hemoglobin Humans Hypoglycemia Hypoglycemia - epidemiology Hypoglycemia - etiology Insulin Male Medical sciences Miscellaneous Neurology Nursing Older people Public health. Hygiene Public health. Hygiene-occupational medicine Risk Factors Veterans |
| title | Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy |
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