Aetiology Cohort study

Cognitive impairment is a major risk factor for serious hypoglycaemia; public health intervention is warranted 10.1136/eb-2013-101525 Denise G Feil,1,2 Leonard M Pogach3,4 1

VA Greater Los Angeles Center of Innovation Center of Excellence, Health Services Research and Development, Sepulveda, CA, USA; 2 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 3Department of Veterans Affairs, New Jersey Healthcare System, East Orange, New Jersey, USA; 4Rutgers University-NJMS, Newark, New Jersey, USA Correspondence to: Dr Denise G Feil, Division of Geriatric Psychiatry, West Los Angeles VA Healthcare Center—11301 Wilshire Blvd., 116-AE Los Angeles, CA 90073, USA; [email protected]

Commentary on: Yaffe K, Falvey CM, Hamilton N, et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013;173:1300–6.

Context Severe hypoglycaemia in persons with diabetes mellitus (DM) has received recognition as a major public health problem in recent years.1 Recently the US Department of Health and Human Services proposed a National Action Plan2 for hypoglycaemic safety that emphasises known risk factors for severe hypoglycaemia, including cognitive impairment (CogI) and dementia (D). Yaffe and colleagues add to the epidemiological evidence defining this at-risk population.

Methods The authors used a 12-year longitudinal population-based study of 783 older, multiracial, multiethnic adults with DM to evaluate whether CogI or D increases the risk of developing a severe hypoglycaemic event and whether prior hypoglycaemia increases the risk of CogI or D. A review of inpatient records measured hypoglycaemia as well as D, while a review of D medication prescription was also conducted. Cox proportional hazards regression models were used to test for associations and results were expressed as multivariate-adjusted HR.

Findings Older adults with diabetes and incident D had a greater risk of major hypoglycaemia than those without D (14.2% vs 6.3%, HR=3.1, 95% CI 1.5 to 6.6, p

Cognitive impairment is a major risk factor for serious hypoglycaemia; public health intervention is warranted.

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