Send to

Choose Destination
J Am Med Dir Assoc. 2015 Apr;16(4):349.e7-12. doi: 10.1016/j.jamda.2014.12.014. Epub 2015 Feb 7.

Severe hypoglycemia is associated with antidiabetic oral treatment compared with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the DIMORA study.

Author information

Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy. Electronic address:
Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
Department of Geriatrics, Campus Bio-Medico University, Rome, Italy.
Azienda ULSS, Geriatrics Unit, St. Antonio Hospital, Padua, Italy.
Department of Health Sciences, University of Milano-Bicocca, Milan, Italy; Acute Geriatric Unit, S Gerardo Hospital, Monza, Italy; Milan Center for Neuroscicence (Neuro-Mi), Milan, Italy.
National Research Council (CNR), Neuroscience Institute Aging Branch, Padua, Italy.
Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.



Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status.


Cross-sectional observational study.


A total of 150 nursing homes across Italy.


A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120).


Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents.


Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia.


In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer.


Severe hypoglycemia; aging; antidiabetic oral agents; dementia; insulin analogs

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center