Hypoglycaemia in older people with dementia and diabetes

Mattishent, Katharina (2019) Hypoglycaemia in older people with dementia and diabetes. Doctoral thesis, University of East Anglia.

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Abstract

Objective
To explore the effect of hypoglycaemia on adverse events in older people with diabetes and dementia and determine the feasibility of using continuous glucose monitoring in this patient group.
Methods
Systematic review on continuous glucose monitoring in older people with diabetes: Hypothesis-generating systematic review to inform my feasibility study and to identify gaps in the evidence.
Feasibility study: I conducted a feasibility study of continuous blood glucose monitoring to explore continuous glucose monitoring in older people with diabetes and memory problems.
Pharmacoepidemiological study: Retrospective cohort study using the Clinical Research Practice Datalink database to test the effect of exposure to hypoglycaemia in older patients with dementia.
Systematic review and meta-analysis on the associations between hypoglycaemia and adverse events in older people treated with glucose-lowering agents: Updated systematic review and meta-analysis of serious adverse events associated with hypoglycaemia in older patients treated with glucose-lowering agents.
Findings
Systematic review on continuous glucose monitoring in older people with diabetes: 9 studies were included with a total of nearly 1000 patients. Hypoglycaemic episodes occurred in a sizeable proportion and most of these episodes were asymptomatic. Some patients spent nearly 2 hours per day in the hypoglycaemic range. CGM is acceptable to patients and improved health-related well-being.
Feasibility study: 12 participants completed the study and found using CGM device acceptable. Data capture with this device varied considerably (3%-92%). The device captured hypoglycaemic episodes in 6 participants, two of which lasted for over 300 minutes.
Pharmacoepidemiological study: Older people with dementia and diabetes who have had a hypoglycaemic event are at substantially higher risk of death, cardiovascular events, falls, fractures and emergency department attendances, than those who have not had a hypoglycaemic event.
Systematic review and meta-analysis on the associations between hypoglycaemia and adverse events in older people treated with glucose-lowering agents: 42 included studies with over 2 million patients. Hypoglycaemia is associated with an 80% increased risk in vascular complications, a doubling in risk of all-cause mortality, a 55% increased risk in dementia, and a 78% and 68% increased risk in falls and fractures respectively.
Conclusions
My research has highlighted the complications associated with hypoglycaemia in older people with diabetes and dementia and set the ground work for future studies using continuous glucose monitoring in this patient group.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	12 Feb 2020 12:09
Last Modified:	12 Feb 2020 12:09
URI:	https://ueaeprints.uea.ac.uk/id/eprint/74170
DOI:

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