(Press-News.org) A study of older adults with diabetes mellitus (DM) suggests a bidirectional association between hypoglycemic (low blood glucose) events and dementia, according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication.
There is a growing body of evidence that DM may increase the risk for developing cognitive impairment, including Alzheimer disease and vascular dementia, and there is research interest in whether DM treatment can prevent cognitive decline. When blood glucose declines to low levels, cognitive function is impaired and severe hypoglycemia may cause neuronal damage. Previous research on the potential association between hypoglycemia and cognitive impairment has produced conflicting results, the authors write in the study background.
Kristine Yaffe, M.D., of the University of California, San Francisco, and colleagues studied 783 older adults with DM (average age 74 years). During a 12-year follow-up, 61 patients (7.8 percent) had a reported hypoglycemic event and 148 (18.9 percent) developed dementia.
"Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia," according to the study.
Patients who experienced a hypoglycemic event had a two-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4 percent vs. 17.6 percent). Older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with patients who did not develop dementia (14.2 percent vs. 6.3 percent), according to the study results.
"Among older adults with DM who were without evidence of cognitive impairment at study baseline, we found that clinically significant hypoglycemia was associated with a two-fold increased risk for developing dementia … Similarly, participants with dementia were more likely to experience a severe hypoglycemic event," the authors conclude. "The association remained even after adjustment for age, sex, educational level, race/ethnicity, comorbidities and other covariates. These results provide evidence for a reciprocal association between hypoglycemia and dementia among older adults with DM."
###
(JAMA Intern Med. Published online June 10, 2013. doi:10.1001/jamainternmed.2013.6176. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: An author made a conflict of interest disclosure. This work was supported by grants from the National Institute on Aging, the National Institute of Nursing Research and other sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Glucose Control in Older Adults with Diabetes – More Harm Than Good?
In an invited commentary, Kasia J. Lipska, M.D., M.H.S. of the Yale University School of Medicine, New Haven, Conn., and Victor M. Montori, M.D., of the Mayo Clinic, Rochester, Minn., write: "Hypoglycemia is a major adverse consequence of glucose-lowering therapy in patients with type 2 diabetes mellitus (DM). … Older patients are at higher risk of hypoglycemia. Aging-related changes in renal function and drug clearance may contribute to this vulnerability."
"Efforts to mitigate the risk of hypoglycemia are clearly warranted to improve quality of life and potentially prevent the associated adverse events," they continue.
"Hypoglycemia in the course of type 2 DM treatment is both common and associated with poor outcomes. Therefore, decisions about the intensity and type of antihyperglycemic therapy must take into account the harms of hypoglycemia. Involving patients in these treatment decisions may favorably shift the current glucose-centric paradigm to a more holistic patient-centered one," they conclude.
(JAMA Intern Med. Published online June 10, 2013. doi:10.1001/jamainternmed.2013.6189. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Association between hypoglycemia, dementia in older adults with diabetes
2013-06-11
ELSE PRESS RELEASES FROM THIS DATE:
Low diastolic blood pressure may be associated with brain atrophy
2013-06-11
Low baseline diastolic blood pressure (DBP) appears to be associated with brain atrophy in patients with arterial disease, whenever declining levels of blood pressure (BP) over time among patients who had a higher baseline BP were associated with less progression of atrophy, according to a report published Online First by JAMA Neurology, a JAMA Network publication.
"Studies have shown that both high and low blood pressure (BP) may play a role in the etiology of brain atrophy. High BP in midlife has been associated with more brain atrophy later in life, whereas studies ...
Genetic research clarifies link between hypertension and vitamin D deficiency
2013-06-11
Paris, France: Low levels of vitamin D can trigger hypertension, according to the world's largest study to examine the causal association between the two. Although observational studies have already shown this link, a large-scale genetic study was necessary before the cause and effect could be proven, the annual conference of the European Society of Human Genetics (ESHG) will hear today (Tuesday).
Dr. Vimal Karani S, from the Institute of Child Health, University College London, London, UK, will tell the meeting that data from the D-CarDia collaboration, involving 35 ...
UMD scientists publish key findings on regional, global impact of trade on the environment
2013-06-11
COLLEGE PARK, Md. -- In the wake of concerns over climate change and other emergent environmental issues, both individuals and governments are examining the impact of consumer and producer behavior and policies. In two new studies, three researchers from the University of Maryland's Department of Geographical Sciences publish groundbreaking findings on the environmental impact of globalization, production and trade at both regional and international scales, and anticipate that their research will inform key environmental policies and consumer and corporate attitudes in ...
Medicare beneficiaries substantially more likely to use brand-name drugs than VA patients
2013-06-11
PITTSBURGH, June 10, 2013 – Medicare beneficiaries with diabetes are two to three times more likely to use expensive brand-name drugs than a comparable group of patients treated within the VA Healthcare System, according to a nationwide study by researchers from the University of Pittsburgh, VA Pittsburgh Healthcare System and Dartmouth College.
Spending in Medicare Part D would have been an estimated $1.4 billion less in 2008 if brand-name and generic drug use matched that of the VA for the medications studied. The report, the first large-scale comparison of prescription ...
Unfrozen mystery: H2O reveals a new secret
2013-06-11
Washington, D.C.—Using revolutionary new techniques, a team led by Carnegie's Malcolm Guthrie has made a striking discovery about how ice behaves under pressure, changing ideas that date back almost 50 years. Their findings could alter our understanding of how the water molecule responds to conditions found deep within planets and could have implications for energy science. Their work is published in the Proceedings of the National Academy of Sciences.
When water freezes into ice, its molecules are bound together in a crystalline lattice held together by hydrogen bonds. ...
Men with prostate cancer should eat healthy vegetable fats
2013-06-11
Men with prostate cancer may significantly improve their survival chances with a simple change in their diet, a new study led by UC San Francisco has found.
By substituting healthy vegetable fats – such as olive and canola oils, nuts, seeds and avocados – for animal fats and carbohydrates, men with the disease had a markedly lower risk of developing lethal prostate cancer and dying from other causes, according to the study.
The research, involving nearly 4,600 men with non-metastatic prostate cancer, could help with the development of dietary guidelines for men with ...
To germinate, or not to germinate, that is the question…
2013-06-11
Scientists at the University of York have uncovered new insights into the way seeds use gene networks to control when they germinate in response to environmental signals.
Timing of seed germination is crucial for survival of plants in the wild and is also important for commercial seed production where there is a need to ensure uniform growth.
A cold environment can signal an imminent winter so the mother plant produces dormant seeds that will not grow until the following spring. A warmer environment can signal an early summer with the mother plant producing seeds that ...
Reputation can trump money
2013-06-11
Whether it's an effort to increase recycling rates, reduce energy usage or cut carbon emissions, the conventional wisdom says that the best way to get people to do the right thing is to make it worth their while with cold, hard cash.
But Harvard researchers say there may be an easier, cheaper way – by appealing to people's reputation, not their wallets.
Using enrollment of thousands of people in a California blackout prevention program as an experimental test bed, a team of researchers that included Erez Yoeli, a researcher at the Federal Trade Commission, Moshe Hoffman, ...
Shape of nanoparticles points the way toward more targeted drugs
2013-06-11
LA JOLLA, Calif., June 10, 2013 — Conventional treatments for diseases such as cancer can carry harmful side effects—and the primary reason is that such treatments are not targeted specifically to the cells of the body where they're needed. What if drugs for cancer, cardiovascular disease, and other diseases can be targeted specifically and only to cells that need the medicine, and leave normal tissues untouched?
A new study involving Sanford-Burnham Medical Research Institute's Erkki Ruoslahti, M.D., Ph.D., contributing to work by Samir Mitragotri, Ph.D., at the University ...
Brain circuits link obsessive-compulsive behavior and obesity
2013-06-11
What started as an experiment to probe brain circuits involved in compulsive behavior has revealed a surprising connection with obesity.
The University of Iowa-led researchers bred mice missing a gene known to cause obesity, and suspected to also be involved in compulsive behavior, with a genetic mouse model of compulsive grooming. The unexpected result was offspring that were neither compulsive groomers nor obese.
The study, published the week of June 10 in the online early edition of the Proceedings of the National Academy of Sciences (PNAS), suggests that the ...