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Diabetes status may influence type of medication prescribed for dementia
Adults with diabetes are often diagnosed with dementia disorders at a younger age compared with adults without diabetes and are less likely to be prescribed cholinesterase inhibitors or memantine for the disorders, according to researchers in Sweden.
“The main finding is that Swedish patients with Alzheimer's disease and diabetes mellitus are less frequently treated with acetylcholinesterase inhibitors and memantine — the only available drugs for Alzheimer's disease today,” Juraj Sečník, MD, a PhD student at the Center for Alzheimer Research at Karolinska Institutet in Sweden, told Endocrine Today. “In addition, diabetic patients had the diagnosis of dementia sooner and were less commonly diagnosed with dementia with Lewy bodies & Parkinson's disease dementia compared to non-diabetic patients.”
Sečník and colleagues evaluated data from the Swedish Dementia Registry on 29,630 older adults with dementia to determine the differences in clinical characteristics and pharmacologic treatment between those with and without diabetes. Data from the combined Swedish Patient Register and Prescribed Drug Register were used for information on diabetes diagnoses. The Swedish Prescribed Drug Register was evaluated for data on antidiabetic, dementia, cardiovascular and psychotropic medication information.
Overall, 4,881 participants were diagnosed with diabetes. Compared with participants without diabetes, those with diabetes were younger (78.8 years vs. 79.5 years; P < .001) and less likely to be women (51.5% vs. 60.9%; P < .001) and had slightly lower global cognitive status measured by the Mini Mental State Exam (scores, 20.9 vs. 21.2; P = .001). The frequencies of the following dementia disorders were lower in participants with diabetes compared with those without diabetes: Alzheimer’s disease (23.5% vs. 34.2%; P < .001), dementia with Lewy bodies (1.3% vs. 2.4%; P < .001) and Parkinson’s disease dementia (0.9% vs. 1.6%; P < .001). However, the frequencies of vascular dementia (26.9% vs. 16.9%; P < .001) and mixed dementia (20.7% vs. 18.6%; P = .001) were higher in participants with diabetes compared with those without. No differences were found in frequencies of frontotemporal dementia or unspecified dementia in participants with and without diabetes.
Participants with diabetes were prescribed more drugs (median, 7) compared with participants without diabetes (median, 4; P < .001). Antithrombotic (P < .001), cardiac (P < .001), antihypertensive (P < .001) and statin (P < .001) drugs were prescribed more frequently in participants with diabetes compared with those without diabetes. However, participants with diabetes were less likely to be prescribed cholinesterase inhibitors for a diagnosis of Alzheimer’s disease (OR = 0.78; 99% CI, 0.63-0.95), mixed dementia (OR = 0.69; 99% CI, 0.56-0.85) or vascular dementia (OR = 0.68; 99% CI, 0.49-0.95) and less likely to be prescribed memantine for treatment of Alzheimer’s disease (OR = 0.68; 99% CI, 0.54-0.85) or unspecified dementia (OR = 0.7; 99% CI, 0.5-0.97) compared with participants without diabetes.
“The results of our study imply that Swedish patients with diabetes and dementia receive less optimal treatment for Alzheimer’s disease,” Sečník told Endocrine Today. “The main reason is not clear by it could be due to doctors’ reluctance to prescribe more medication as the drug usage in diabetic patients was already high in our sample. A similar trend was apparent for mixed dementia — a dementia exhibiting both Alzhermer’s and vascular pathology. We suggest, that these patient groups should be treated with these drugs, even though we understand the probable caution in additional prescription, risking polypharmacy. Where possible, rearranging and reducing the medication could provide room for these drugs. Also, other factors restricting the prescription of these drugs could play a role, but we did not identify them in our study.” – by Amber Cox
For more information:
Juraj Secnik, MD, can be reached at juraj.secnik@ki.se.
Disclosures: The researchers report no relevant financial disclosures.