Abstract
Objectives
To compare diabetes monitoring and the incidence of acute diabetic complications between
patients with and without incident Alzheimer's Disease and Related Syndromes (ADRS).
Design
Longitudinal observational study from 2010 to 2014.
Setting
Data from the French national health system database.
Participants
The France-Démence cohort: individuals aged 65 years or older suffering from incident
ADRS, based on long-term disease registry, hospitalization for dementia, or antidementia
drug delivery. They were matched (1:1) to a pair free of ADRS on age, sex, residence
area, and insurance scheme. This study included France-Démence population with known
diabetes for at least 2 years.
Measurements
Data related to diabetes control and complications: biological monitoring such as
glycated hemoglobin A1c (HbA1c, ≥1/y, ≥2/y), lipid profile, microalbuminuria; eye examination; hospitalization for
diabetes-related complications such as coma with ketoacidosis; and hospitalization
for hypoglycemia were studied between the year prior to ADRS identification (Y-1) and the 2 following years (Y0; Y1). Incidences between the 2 groups (ADRS/non-ADRS) were compared using age-standardized
incidence ratios (SIR).
Results
The studied population included 87,816 individuals. HbA1c determination was less frequent
in ADRS group, no matter the study period and the minimal annual threshold used. Respectively,
82.6% and 88.5% of ADRS and non-ADRS group had at least 1 HbA1c testing during Y-1 [SIR = 0.94, 95% confidence interval (CI) 0.93–0.95], 73.4% and 89.0% during Y0 (SIR = 0.83, 95% CI 0.82–0.84), and 75.4% and 89.3% during Y1 (SIR = 0.85, 95% CI 0.83‒0.86). Subjects with ADRS were also consistently more hospitalized
than non-ADRS peers. The gap was maximal in the year following the diagnosis, as observed
for hospitalizations for any cause related to diabetes (SIR Y-1: 2.04, Y0: 3.14, Y1: 1.67), diabetes mellitus with coma (SIR Y-1: 3.84, Y0: 9.30, Y1: 3.06), and hypoglycemia (SIR Y-1: 4.20, Y0: 5.25, Y1: 2.27).
Conclusions
Incident ADRS is associated with a less frequent diabetes monitoring and an increased
risk of diabetes complications compared with older people without ADRS. Our study
questions healthcare quality offered to participants with ADRS in comorbidity control.
Further investigations are required to explain the mechanisms underlying our results
and to propose actions to improve care of patients with ADRS.
Keywords
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Article info
Publication history
Published online: February 04, 2018
Footnotes
This study was funded by a grant from Toulouse University Hospital (local bidding, AOL 2016).
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
