Endocrine Abstracts

Background: The association between diabetes and dementia has been well documented (1, 2, 3) and with Australia’s aging population, the already significant disease burden of both pathologies will inevitably progress over time. Despite both being progressive pathologies which escalate over time, there have not been any studies pertaining to degree of glycaemic control and the extent to which this relates to prevalence of dementia.

Aims: To determine association between diabetic control and prevalence of dementia. Secondary aims are 1) Assessment of the role of having stringent control to reduce prevalence of dementia and 2) Juxtaposition of risks relating to tight control in terms of rates of hypoglycaemia.

Methods: Retrospective study of 128 admissions between 1^st January to 31^st December 2016 were studied. 25 variables were analyzed. Partition modelling was used to identify variables which could affect outcomes, and hence, measure impact of variables upon incidence of dementia and macro/microvascular complications. Chi square analysis was utilized to determine statistical significance.

Results: 128 admissions met inclusion criteria (mean age 84, SD =5.6, male =39%). Mean length of stay was 30 days. Dementia was associated with suboptimal glycemic control, while tightly controlled BSL’s (blood sugar level) had minimal impact upon rates of hypoglycaemia, until post prandial BSL’s dropped below 7. We found that a range of 7–10 mmol/L, reflecting the current gold standard of <11.1 mmol/L (4) would result in reductions in dementia prevalence, length of stay and readmission rates by 41%, 6.43 days and 0.58 admissions per year respectively.

Conclusions: Our recommendation is that single agent regimens in elderly diabetic patients with targets between 7–10 mmol/L, which resulted in hospital budget benefit of $2,438,696.96 per annum in the context of a 30 bed Acute Geriatric Unit.

References

1) Luchsinger JA, Reitz C, Honig LS, Tang MX, Shea S, Mayeux R. Aggregation of Vascular Risk Factors and Risk of Incident Alzheimer’s Disease. Neurology. 2005;65(4):545–551.

2) Arvanitakis Z, Wilson RS, Bienias JL, Evans DA, Bennett DA. Diabetes Mellitus and Risk of Alzheimer Disease and Decline in Cognitive Function. Arch Neurol. 2004;61:661–666.

3) Borenstein AR, Wu Y, Mortimer JA, Schellenberg GD, McCormick WC, Bowen JD, et al. Developmental and vascular risk factors for Alzheimer’s disease. Neurobiol Aging. 2005;26:325–334.

4) Cho NH, Colagiuri S, Distiller L, Dong B, Dunning T, Gadsby R et al. Managing Older people with Type 2 Diabetes. International Diabetes Federation. 2013.