Are Australians living with dementia overtreated for diabetes?
A new study by Monash University has found Australians living with dementia are potentially being overtreated for diabetes, despite clinical guidelines recommending a less stringent approach to treating diabetes for people with coexisting dementia.
The national cohort study, published in the Journal of the American Geriatrics Society and led by the Centre for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences, compared people aged 65–97 years living with both dementia and diabetes, with a general population cohort living with just diabetes.
Overall, the study found that more people with dementia were dispensed insulin and sulfonylureas than the general population. While these diabetes medications are effective they are also associated with risk of adverse events, particularly among people who are older and frail.
Corresponding author of the study and CMUS PhD candidate, Leonie Picton, said the risks associated with tight glycemic control, such as hypoglycemia and hypoglycemic coma, may outweigh the benefits in people with diabetes who have dementia.
“In recognition of this increased risk, clinical practice guidelines for diabetes recommend less stringent treatment targets for people with coexisting dementia,” said Mrs Picton.
“However, we found the opposite is happening - people are not having having medication regimens deintensified after dementia diagnosis, leading to potential overtreatment.
“Our study showed the use of insulin increased in the dementia population and decreased in the general population. This could be attributed to a number of factors; for example it’s possible that the people initiating or increasing insulin use have more severe diabetes, warranting more intense treatment. However, it may also be that overtreatment is occurring, which is concerning because adverse events from insulin are among the most common reasons for emergency department visits in older people.”
The most up to date guidelines recommend prescribers consider where a patient sits on the spectrum of clinical and functional status when reviewing medication regimens, highlighting cognitive impairment as a reason for relaxing treatment targets.
Senior author, Dr Jenni Ilomaki from CMUS, said prescribers should consider the risks associated with diabetes medicines when reviewing treatments for people living with dementia.
“People with diabetes have a higher risk of developing dementia, and prescribers may intensify diabetes treatments if cognitive deficits appear, in an effort to reduce the risk of dementia,” said Dr Ilomaki.
“However, a recent Cochrane review has found no evidence that intensifying diabetes treatments reduces dementia, whereas greater exposure to these high-risk medications may be an important factor contributing to higher hospitalisation rates for people living with dementia.”
To read the full paper, entitled "Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study", click here.
Leonie Picton is supported by a research training scholarship provided by the Australian Government.
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