Severe Hypoglycemia May Raise Dementia Risk

Objective:To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes.Methods:A longitudinal cohort study followed 2,821 members of an integrated healthcare delivery system with type 1 diabetes from 1997-2015. Hypoglycemic and hyperglycemic events requiring emergency room or hospitalization were abstracted from medical records beginning 1/1/1996 through cohort entry. Participants were followed for dementia diagnosis through 9/30/2015. Dementia risk was examined using Cox proportional hazard models adjusted for age (as timescale), sex, race/ethnicity, HbA1c, depression, stroke, and nephropathy.Results:Among 2,821 older adults (mean age 56) with type 1 diabetes, 398 (14%) had a history of severe hypoglycemia, 335 (12%) severe hyperglycemia and 87 (3%) both. Over a mean 6.9 years of follow-up, 153 individuals (5.4%) developed dementia. In fully adjusted models, individuals with hypoglycemic events had 66% greater risk of dementia than those without a hypoglycemic event (HR=1.66; 95% CI: 1.09, 2.53), while those with hyperglycemic events had >2 times the risk (HR=2.11; 95% CI: 1.24, 3.59) than those without a hyperglycemic event. There was a 6-fold greater risk of dementia in individuals with both severe hypoglycemia and hyperglycemia versus those with neither (HR=6.20; 95% CI: 3.02, 12.70).Conclusions:For older individuals with type 1 diabetes, severe hypoglycemic and hyperglycemic events are associated with increased future risk of dementia.

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Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-Based Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab860 ◽

2022 ◽

Author(s):

Eugene Han ◽

Kyung-do Han ◽

Byung-Wan Lee ◽

Eun Seok Kang ◽

Bong-Soo Cha ◽

...

Keyword(s):

Type 2 Diabetes ◽

Alzheimer Disease ◽

Vascular Dementia ◽

Severe Hypoglycemia ◽

National Health Insurance System ◽

Health Checkup ◽

Risk Of Death ◽

Dementia Risk ◽

Overall Mortality

Abstract Context There are few studies focused on the relationship between hypoglycemia and new-onset dementia in patients with type 2 diabetes and no study regarding mortality of dementia after hypoglycemia. Objective We investigated the effect of severe hypoglycemia on dementia subtypes and its relation to overall mortality in patients with type 2 diabetes. Methods We evaluated incident dementia, including Alzheimer disease and vascular dementia, among health checkup participants aged 40 years or older in the National Health Insurance System in Korea from January 2009 to December 2015. Episodes of severe hypoglycemia were examined for 3 years before the date of the health checkup. Results Among 2 032 689 participants (1 172 271 men, 860 418 women), 14 443 (0.7%) experienced severe hypoglycemia, during a mean follow-up period of 6.9 ± 1.7 years. Individuals in the severe hypoglycemia group were more likely to be diagnosed with dementia compared to individuals without severe hypoglycemia (23.3% vs 7.3%; P < .001) and the overall incidence of Alzheimer disease was higher than vascular dementia. Dementia risk rose with increasing number of severe hypoglycemic episodes (1 episode [hazard ratio (HR) = 1.54; 95% CI, 1.48-1.60], 2 or more episodes [HR = 1.80; 95% CI, 1.66-1.94]). Overall mortality was higher in participants with dementia, but without severe hypoglycemia (HR = 2.03; 95% CI, 1.96-2.10) and severe hypoglycemia, but without dementia (HR = 4.24; 95% CI, 4.29-4.40), and risk of death was highest in those with both severe hypoglycemia and dementia (HR = 5.08; 95% CI, 4.83-5.35). Conclusion Severe hypoglycemia is associated with dementia, especially Alzheimer disease and mortality; together, they have an additive effect on overall mortality.

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Severe Hypoglycemia Raises Dementia Risk in Type 2 Elderly

Clinical Psychiatry News ◽

10.1016/s0270-6644(10)70140-5 ◽

2010 ◽

Vol 38 (3) ◽

pp. 22 ◽

Cited By ~ 1

Author(s):

MIRIAM E. TUCKER

Keyword(s):

Severe Hypoglycemia ◽

Dementia Risk

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Silver Staining of Pancreatic Islets as Revealed by Electron Microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100060234 ◽

1967 ◽

Vol 25 ◽

pp. 44-45

Author(s):

Kazuaki Misugi ◽

Nobuko Misugi ◽

Hiroshi Yamada

Keyword(s):

Pancreatic Islet ◽

Silver Staining ◽

Islet Cells ◽

Severe Hypoglycemia ◽

Granular Cell ◽

Electron Microscopic Level ◽

Staining Reaction ◽

Electron Microscopic ◽

Pancreatic Islet Cell ◽

D Cell

The authors had described the fine structure of a type of pancreatic islet cell, which appeared different from typical alpha and beta cells, and tentatively considered that this third type of granular cell probably represents the D cell (Figure 1).Since silver staining has been widely used to differentiate different types of pancreatic islet cells by light microscopy, an attempt to examine this staining reaction at the electron microscopic level was made.Material and Method: Surgically removed specimens from three infants who suffered from severe hypoglycemia were used. The specimens were fixed and preserved in 20% neutral formalin. Frozen sections, 30 to 40 micron thick, were prepared and they were stained by Bielschowsky's method as modified by Suzuki (2). The stained sections were examined under a microscope and islet tissues were isolated. They were fixed in 1% osmium tetroxide in phosphate buffer for one hour and embedded in Epon 812 following dehydration through a series of alcohols and propylene oxide.

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