Low hemoglobin A1c and low body mass index are associated with dementia and activities of daily living disability among Japanese nursing home residents with diabetes

Abstract

Aim: To investigate associations between glycemic control and dementia, activities of daily living (ADL), falls and fractures in Japanese older adults with type 2 diabetes mellitus living in nursing homes.Methods: A total of 384 older residents with diabetes aged ≥65 years from 95 out of 132 facilities in Hiroshima Prefecture were studied in a cross-sectional study in 2016. Primary outcomes were differences in severity of dementia and ADL among three glycosylated hemoglobin level groups. Secondary end-points included differences in falls, fragility fracture and severe hypoglycemia.Results: Approximately 67.6% of patients receiving any diabetes treatment received dipeptidyl peptidase-4 inhibitors, and 26.0% received sulfonylureas. Patients with glycosylated hemoglobin <7.0% had a significantly higher severity of dementia compared with those with glycosylated hemoglobin 7.0-7.9% (beta AE SE, 0.55 AE 0.26; 95% CI 0.04-1.06) in multivariable ordinal logistic regression analysis. This tendency was observed particularly in patients using insulin (1.91 AE 0.91; 95% CI 0.13-3.69) or both sulfonylureas and dipeptidyl peptidase 4 (2.14 AE 0.88; 95% CI 0.41-3.87). Low body mass index was significantly associated with dementia (−0.08 AE 0.03; 95% CI −0.14 -−0.03) and ADL impairment (−0.15 AE 0.03; 95% CI −0.20 -−0.09), and fractures (odds ratio OR 0.89 per kg/m 2 ; 95% CI 0.84-0.96).Conclusions: Tight glycemic control was related to dementia in residents treated with insulin and sulfonylureas, and low body mass index was associated with dementia, ADL disability and fractures. Optimization of glycemic control and weight for people with diabetes in longterm care facilities could be important for the maintenance of cognitive and physical function.

Concepts of dementia prevention in the health promotion among older adults: A narrative review

“…[ 26 ] Controlling BMI and body weight in older adults is critical for maintaining cognitive and physical functions for dementia prevention. [ 27 ] Dementia prevention is positively correlated with BMI and cognitive function in older adults. [ 28 ] Recent literature indicates that BMI and dementia prevention are associated with older adults’ body weight and BMI measurements in daily life.…”

Hemorrhagic stroke outcomes of KApSR patients with co-morbid diabetes and Alzheimer’s disease

“…Diabetes treatment has been shown to lower amyloid load (39,40). However, the effects of controlling A1c values are controversial in dementia (39)(40)(41)(42) due to adverse effects of hypoglycemias on the brain. DM+/AD+ subjects in KApSR have lower A1c's, indicating controlled diabetes, but significantly worse NIHSS following hemorrhagic stroke.…”

Bone Health in the Elderly with Type 2 Diabetes Mellitus–A Systematic Review

“…Most articles (N = 49) reported an increased risk of fracture in at least one location associated with the presence of diabetes or diabetes-related parameters. A total of 13 studies reported no association of fracture risk with T2DM [32,75,[89][90][91][92], HbA1c levels [38,62,80,[93][94][95][96], fasting plasma glucose [38,62], HOMA indices [90], or diabetes duration [32,62,80,95]. Five of these studies reported no associations in any of the analyses performed [32,38,75,89,93].…”

“…A total of 13 studies reported no association of fracture risk with T2DM [32,75,[89][90][91][92], HbA1c levels [38,62,80,[93][94][95][96], fasting plasma glucose [38,62], HOMA indices [90], or diabetes duration [32,62,80,95]. Five of these studies reported no associations in any of the analyses performed [32,38,75,89,93]. Six studies reported reduced fracture risk in at least one location associated with the presence of diabetes [51,81,95,[97][98][99] or higher HbA1c levels [97]; four of these studies were relatively small (the largest with n = 5,931) case-control studies investigating fracture prevalence [51,81,95,99], whereas the remaining two were retrospective cohort studies investigating fracture incidence [97,98].…”

“…The majority of these articles reported an increased risk associated with diabetes [14, 69, 71, 80, 102, 105, 108, 111-113, 123, 126-130], with glycemia in individuals with T2DM (higher levels of HbA1c or FPG, with cut-offs varying among studies) [69,90,128], with longer disease duration [92,105,123,131], or with diabetic complications [92,102]. Few articles reported no increased risk of overall or clustered fracture types [38,51,81,89,93,95,97,99,103]. In the articles that reported an effect on the overall risk of clustered fracture types, effect sizes (ORs or HRs) were around 1.20 [102,108,112].…”