Dia iabetes care and dementia among old lder adults: a nati - - PowerPoint PPT Presentation

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Dia iabetes care and dementia among old lder adults: a nati tionwide 3-year lo longitudinal stu tudy Wargny M, Gallini A, Hanaire H, Nourhashemi F, Andrieu S, Gardette V UMR 1027 Epidemiology and analyses in public health EUGMS, Nice

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Dia iabetes care and dementia among old lder adults: a nati tionwide 3-year lo longitudinal stu tudy

Wargny M, Gallini A, Hanaire H, Nourhashemi F, Andrieu S, Gardette V

UMR 1027 Epidemiology and analyses in public health EUGMS, Nice September 20/22 2017

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Conflict of interest disclosure

  • I have no potential conflict of interest to report
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Diabetes and dementia

  • Co-occurrence diabetes - dementia
  • 6-39% of patients with dementia suffer from diabetes
  • Challenges for care
  • Dementia: a “discordant” comorbidity towards diabetes (Piette and Kerr 2006)
  • Lack of guidelines for clinicians
  • Impact of dementia on diabetes care
  • Few studies with discordant results (Zhang 2010, Thorpe 2012, Connolly 2013, Müther

2010)

  • No data available with a longitudinal perspective
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Aim

  • To assess whether incident dementia affects the frequency of
  • diabetes-related health service use and
  • diabetes-related hospitalizations

in French older adults during the year preceding dementia identification and the 2 following years

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Design and population

  • Longitudinal cohort study
  • Data source: FRA-DEM cohort study in national health system database

(SNIIRAM)

  • all cases of incident dementia in France in 2011-2012
  • Based on 1 of 3 criteria: long-term disease registration (ICD-10 F00-F03, G30, G31), hospitalisation

(ICD-10 F00-F03, G30, G31), anti-dementia drug (cholinesterase inhibitor, memantine)

  • 5 year-window free of dementia criteria
  • a random sample of subjects without dementia matched (1:1) on age, sex, residence

area and insurance scheme

  • ≥ 65 years old
  • Diabetes mellitus
  • long-term disease registration (ICD-10 E10-E14) with start date > 2 years before dementia

identification

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Outcomes

  • Health resource use related to diabetes control and prevention of

complications

  • Biological monitoring: HbA1c, lipid profile, microalbuminuria
  • Eye examination
  • Diabetes-related hospitalisations
  • All diabetes-related hospitalisations
  • Diabetes-related coma
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Analysis

  • Yearly incidences for 3 years
  • Standardized incidence ratios (SIR) between subjects with and

without dementia with 95% confidence intervals

  • Indirect standardisation on age (5-year classes)
  • Sensitivity analyses
  • On the uncensored population
  • Excluding subjects with dementia identified through hospitalisation

Y-1 Y0 Y1

Dementia identification (in 2011- 2012)

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Results

  • 87 816 subjects (40 117 with dementia)
  • Mean age ± SD : 81.8 ± 6.7
  • 57% female
  • 86% type 2 diabetes
  • 50% with cardiovascular disease
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At least 2 HbA1c tests in a given year

%

73,6 73,4 74,7 10 20 30 40 50 60 70 80

Y-1 Y0 Y1

With dementia Without dementia

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At least 2 HbA1c tests in a given year

SIR (CI95%)

Y0 Y1 Y-1

%

65,5 54,6 58,8 73,6 73,4 74,7 10 20 30 40 50 60 70 80

Y-1 Y0 Y1

With dementia Without dementia

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LDL-cholesterol Microalbuminuria

16,1 10,6 11,6 21,8 21,2 21,5 10 20 30 40 50 60 70 80 Y-1 Y0 Y1 With dementia Without dementia 56,0 43,0 45,4 63,2 62,3 62,0 10 20 30 40 50 60 70 80 Y-1 Y0 Y1 With dementia Without dementia

SIR CI95% 0.89 0.88-0.90 0.68 0.67-0.69 0.72 0.71-0.74 0.72 0.70-0.74 0.48 0.47-0.50 0.52 0.50-0.53 % %

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Eye examination

SIR CI95% 0.77 0.75-0.78 0.67 0.66-0.68 0.63 0.61-0.64

38,4 32,4 29,5 49,9 47,7 46,5 10 20 30 40 50 60 70 80

Y-1 Y0 Y1

With dementia Without dementia

%

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Diabetes-related hospitalizations

Incidence / 1000 person- years SIR CI95% 2.04 1.97-2.12 3.14 3.04-3.24 1.67 1.59-1.76

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Hospitalizations for diabetes-related coma

Incidence / 1000 person- years SIR CI95% 3.84 3.14-4.65 9.30 8.08-10.64 3.06 2.38-3.88

2,6 5,5 2,0 0,7 0,6 0,6 1 2 3 4 5 6 7 8 9 10 Y-1 Y0 Y1 With dementia Without dementia

Similar trends were seen for hospitalizations for hypoglycemia, falls or hip fractures

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Discussion – conclusion

  • Limitations
  • Diagnoses are not clinically ascertained and no information about severity
  • Inpatient monitoring is only partially captured in the database
  • For all outcomes and years, subjects with dementia were less likely to

receive basic minimal diabetes monitoring

  • Gap worsened over years
  • Reasons (patients, physicians, caregivers) need to be investigated
  • 2- to 9-fold increase in risk of hospitalization for diabetes

complication

  • Despite the low burden of monitoring and lack of financial barriers
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Dia iabetes care and dementia among old lder adults: a nati tionwide 3-year lo longitudinal stu tudy

Wargny M, Gallini A, Hanaire H, Nourhashemi F, Andrieu S, Gardette V

adeline.gallini@univ-tlse3.fr

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17

SIR (IC95%)

A0 A1 A-1 A0 A1 A-1

% ≥ 2 HbA1c dans l’année

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A0 A1 A-1 A0 A1 A-1 A0 A1 A-1 A0 A1 A-1

Comparaison des taux de réalisation des examens biologiques entre les 2 groupes

SIR (IC95%) SIR (IC95%) SIR (IC95%) SIR (IC95%)

≥ 2 HbA1c dans l’année ≥ 1 Triglycérides dans l’année ≥ 1 microalbuminurie dans l’année ≥ 1 créatininémie dans l’année

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Analyse principale Analyse de sensibilité

  • Population non censurée à A1

SIR SIR

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2,04 3,14 1,67 4,13 8,4 2,88

1 3 5 7 9 11 A-1 A0 A1 SIR

Fréquence des recours aux hospitalisations Analyse principale

Liée au diabète Acidocétose ou coma diabétique

2,04 3,14 1,67

1 3 5 7 9 11 A-1 A0 A1 SIR

Fréquence des recours aux hospitalisations Analyse principale

Liée au diabète

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21

FRA-DEM

N = 352 595 paires

ALD diabète

MASA

DIA-FRA-DEM

DIA-FRA-DEM

Temps

A0 A1 (A-1)

NON EXPOSES

DIA-FRA-DEM

MASA à 1 an

N = 40 117 N = 47 699

MASA à 2 ans

N = 31 575 N = 25 838 N = 38 661 N = 43 792

NON EXPOSES

à 1 an Au terme de A1

NON EXPOSES

à 2 ans

36 323 PA 28 583 PA 46 256 PA 41 131 PA

8542 censurés (21,3 %) 5737 censurés (18,2 %) 5131 censurés (11,7 %) 3907 censurés (8,2 %)

Date index

MASA

FRA-DEM

NON-EXPOSES

FRA-DEM

11,4 % 13,5 %

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22

Comparaison des délivrances médicamenteuses entre les 2 groupes

≥ 2 délivrances dans l’année (%) Metformine Insuline Sulfamides hypoglycémiants

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SIR (IC95%)

% ≥ 12 consultations chez un médecin généralistes/an