The Impact of Dementia on Diabetes Control: An Evaluation of HbA1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data

Usha Gungabissoon; Matthew Broadbent; Gayan Perera; Mark Ashworth; Nicholas Galwey; Robert Stewart

doi:10.1016/j.jamda.2022.04.045

The Impact of Dementia on Diabetes Control: An Evaluation of HbA_1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data

Usha Gungabissoon^*, Matthew Broadbent, Gayan Perera, Mark Ashworth, Nicholas Galwey, Robert Stewart

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objectives: Diabetes self-care may become increasingly challenging as cognition declines. We sought to characterize glycated hemoglobin A_1c (HbA_1c) trajectories, markers of diabetes-related management, health care utilization, and mortality in people with preexisting type 2 diabetes (T2D) with and without dementia and based on the extent of cognitive impairment at the time of dementia diagnosis. Design: Retrospective matched cohort study. Setting and Participants: Using a linkage between a primary care (Lambeth DataNet) and a secondary mental healthcare database, up to 5 individuals aged ≥65 y with preexisting T2D without dementia were matched to each individual with dementia based on age, sex, and general practice. Methods: Comparisons were made for HbA_1c trajectories (linear mixed effects models), markers of diabetes-related management and severity at dementia diagnosis (logistic regression), mortality (Cox regression), and health care utilization (multilevel mixed effects binomial regression). Results: In 725 incident dementia and 3154 matched comparators, HbA_1c trajectories differed by dementia status; HbA_1c increased over time for mild dementia and non-dementia, but the increase was greater in the mild dementia group; for those with moderate-severe dementia, HbA_1c decreased over time. Despite individuals with dementia having increased health care utilization around the time of dementia diagnosis, they were less likely to have had routine diabetes-related management. Patients with dementia had a higher prevalence of macrovascular complications and diabetes foot morbidity at dementia diagnosis and a higher mortality risk than those without dementia; these relationships were most marked in those with moderate-severe dementia. Conclusions and Implications: Our study has highlighted important differences in the monitoring, management, and control of diabetes in people with dementia. The effects of frailty and the extent of cognitive impairment on the ability to self-manage diabetes and on glycemic control may need to be considered in treatment guidelines and by primary care.

Original language	English
Pages (from-to)	1555-1563.e4
Journal	Journal Of The American Medical Directors Association
Volume	23
Issue number	9
DOIs	https://doi.org/10.1016/j.jamda.2022.04.045
Publication status	Published - Sept 2022

Keywords

ambulatory care sensitive condition
Dementia
diabetes
HbA

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jamda.2022.04.045

Cite this

@article{3d510aa0e6a44619858509669d9e1382,

title = "The Impact of Dementia on Diabetes Control: An Evaluation of HbA1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data",

abstract = "Objectives: Diabetes self-care may become increasingly challenging as cognition declines. We sought to characterize glycated hemoglobin A1c (HbA1c) trajectories, markers of diabetes-related management, health care utilization, and mortality in people with preexisting type 2 diabetes (T2D) with and without dementia and based on the extent of cognitive impairment at the time of dementia diagnosis. Design: Retrospective matched cohort study. Setting and Participants: Using a linkage between a primary care (Lambeth DataNet) and a secondary mental healthcare database, up to 5 individuals aged ≥65 y with preexisting T2D without dementia were matched to each individual with dementia based on age, sex, and general practice. Methods: Comparisons were made for HbA1c trajectories (linear mixed effects models), markers of diabetes-related management and severity at dementia diagnosis (logistic regression), mortality (Cox regression), and health care utilization (multilevel mixed effects binomial regression). Results: In 725 incident dementia and 3154 matched comparators, HbA1c trajectories differed by dementia status; HbA1c increased over time for mild dementia and non-dementia, but the increase was greater in the mild dementia group; for those with moderate-severe dementia, HbA1c decreased over time. Despite individuals with dementia having increased health care utilization around the time of dementia diagnosis, they were less likely to have had routine diabetes-related management. Patients with dementia had a higher prevalence of macrovascular complications and diabetes foot morbidity at dementia diagnosis and a higher mortality risk than those without dementia; these relationships were most marked in those with moderate-severe dementia. Conclusions and Implications: Our study has highlighted important differences in the monitoring, management, and control of diabetes in people with dementia. The effects of frailty and the extent of cognitive impairment on the ability to self-manage diabetes and on glycemic control may need to be considered in treatment guidelines and by primary care.",

keywords = "ambulatory care sensitive condition, Dementia, diabetes, HbA",

author = "Usha Gungabissoon and Matthew Broadbent and Gayan Perera and Mark Ashworth and Nicholas Galwey and Robert Stewart",

note = "Funding Information: This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London . RS is additionally part-funded by an NIHR Senior Investigator Award ; the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust ; and the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386 ). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding Information: This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London. RS is additionally part-funded by an NIHR Senior Investigator Award; the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust; and the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.UG and NG are employees of GSK, hold stock and receive a salary from GSK. RS has received research support in the last 5 years from Janssen, Takeda, and GSK, and royalties from Oxford University Press. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = sep,

doi = "10.1016/j.jamda.2022.04.045",

language = "English",

volume = "23",

pages = "1555--1563.e4",

journal = "Journal Of The American Medical Directors Association",

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The Impact of Dementia on Diabetes Control: An Evaluation of HbA_1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data. / Gungabissoon, Usha; Broadbent, Matthew; Perera, Gayan et al.
In: Journal Of The American Medical Directors Association, Vol. 23, No. 9, 09.2022, p. 1555-1563.e4.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The Impact of Dementia on Diabetes Control

T2 - An Evaluation of HbA1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data

AU - Gungabissoon, Usha

AU - Broadbent, Matthew

AU - Perera, Gayan

AU - Ashworth, Mark

AU - Galwey, Nicholas

AU - Stewart, Robert

N1 - Funding Information: This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London . RS is additionally part-funded by an NIHR Senior Investigator Award ; the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust ; and the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386 ). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding Information: This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London. RS is additionally part-funded by an NIHR Senior Investigator Award; the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust; and the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.UG and NG are employees of GSK, hold stock and receive a salary from GSK. RS has received research support in the last 5 years from Janssen, Takeda, and GSK, and royalties from Oxford University Press. Publisher Copyright: © 2022 The Authors

PY - 2022/9

Y1 - 2022/9

N2 - Objectives: Diabetes self-care may become increasingly challenging as cognition declines. We sought to characterize glycated hemoglobin A1c (HbA1c) trajectories, markers of diabetes-related management, health care utilization, and mortality in people with preexisting type 2 diabetes (T2D) with and without dementia and based on the extent of cognitive impairment at the time of dementia diagnosis. Design: Retrospective matched cohort study. Setting and Participants: Using a linkage between a primary care (Lambeth DataNet) and a secondary mental healthcare database, up to 5 individuals aged ≥65 y with preexisting T2D without dementia were matched to each individual with dementia based on age, sex, and general practice. Methods: Comparisons were made for HbA1c trajectories (linear mixed effects models), markers of diabetes-related management and severity at dementia diagnosis (logistic regression), mortality (Cox regression), and health care utilization (multilevel mixed effects binomial regression). Results: In 725 incident dementia and 3154 matched comparators, HbA1c trajectories differed by dementia status; HbA1c increased over time for mild dementia and non-dementia, but the increase was greater in the mild dementia group; for those with moderate-severe dementia, HbA1c decreased over time. Despite individuals with dementia having increased health care utilization around the time of dementia diagnosis, they were less likely to have had routine diabetes-related management. Patients with dementia had a higher prevalence of macrovascular complications and diabetes foot morbidity at dementia diagnosis and a higher mortality risk than those without dementia; these relationships were most marked in those with moderate-severe dementia. Conclusions and Implications: Our study has highlighted important differences in the monitoring, management, and control of diabetes in people with dementia. The effects of frailty and the extent of cognitive impairment on the ability to self-manage diabetes and on glycemic control may need to be considered in treatment guidelines and by primary care.

AB - Objectives: Diabetes self-care may become increasingly challenging as cognition declines. We sought to characterize glycated hemoglobin A1c (HbA1c) trajectories, markers of diabetes-related management, health care utilization, and mortality in people with preexisting type 2 diabetes (T2D) with and without dementia and based on the extent of cognitive impairment at the time of dementia diagnosis. Design: Retrospective matched cohort study. Setting and Participants: Using a linkage between a primary care (Lambeth DataNet) and a secondary mental healthcare database, up to 5 individuals aged ≥65 y with preexisting T2D without dementia were matched to each individual with dementia based on age, sex, and general practice. Methods: Comparisons were made for HbA1c trajectories (linear mixed effects models), markers of diabetes-related management and severity at dementia diagnosis (logistic regression), mortality (Cox regression), and health care utilization (multilevel mixed effects binomial regression). Results: In 725 incident dementia and 3154 matched comparators, HbA1c trajectories differed by dementia status; HbA1c increased over time for mild dementia and non-dementia, but the increase was greater in the mild dementia group; for those with moderate-severe dementia, HbA1c decreased over time. Despite individuals with dementia having increased health care utilization around the time of dementia diagnosis, they were less likely to have had routine diabetes-related management. Patients with dementia had a higher prevalence of macrovascular complications and diabetes foot morbidity at dementia diagnosis and a higher mortality risk than those without dementia; these relationships were most marked in those with moderate-severe dementia. Conclusions and Implications: Our study has highlighted important differences in the monitoring, management, and control of diabetes in people with dementia. The effects of frailty and the extent of cognitive impairment on the ability to self-manage diabetes and on glycemic control may need to be considered in treatment guidelines and by primary care.

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KW - diabetes

KW - HbA

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