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Diabetes duration and the risk of dementia: a cohort study based on German health claims data.

ABSTRACT: Diabetes is a risk factor for dementia but little is known about the impact of diabetes duration on the risk of dementia. We investigated the effect of type 2 diabetes duration on the risk of dementia. Prospective cohort study using health claims data representative for the older German population. The data contain information about diagnoses and medical prescriptions from the in- and outpatient sector. We performed piecewise exponential models with a linear and a quadratic term for time since first type 2 diabetes diagnosis to predict the dementia risk in a sample of 13,761 subjects (2,558 dementia cases) older than 65 years. We controlled for severity of diabetes using the Adopted Diabetes Complications Severity Index. We found a U-shaped dementia risk over time. After type 2 diabetes diagnosis the dementia risk decreased (26% after 1 year) and reached a minimum at 4.75 years, followed by an increase through the end of follow-up. The pattern was consistent over different treatment groups, with the strongest U-shape for insulin treatment and for those with diabetes complications at the time of diabetes diagnosis. We identified a non-linear association of type 2 diabetes duration and the risk of dementia. Physicians should closely monitor cognitive function in diabetic patients beyond the first few years after diagnosis, because the later increase in dementia occurred in all treatment groups.

SUBMITTER: Reinke C

PROVIDER: S-EPMC8753043 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Diabetes duration and the risk of dementia: a cohort study based on German health claims data.

Reinke Constantin C Buchmann Nikolaus N Fink Anne A Tegeler Christina C Demuth Ilja I Doblhammer Gabriele G

Age and ageing 20220101 1

<h4>Objective</h4>Diabetes is a risk factor for dementia but little is known about the impact of diabetes duration on the risk of dementia. We investigated the effect of type 2 diabetes duration on the risk of dementia.<h4>Design</h4>Prospective cohort study using health claims data representative for the older German population. The data contain information about diagnoses and medical prescriptions from the in- and outpatient sector.<h4>Methods</h4>We performed piecewise exponential models with ...[more]

PMID: 34923587

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Project description:BackgroundPalliative care aims to ensure a dignified and self-determined life for people facing the end of life. While palliative care is established for tumor diseases, it's notably absent from German medical guidelines for other progressive diseases with an unfavorable prognosis such as dementia. This study will identify predictors of palliative care use in older patients and explore how these predictors relate to the probability of palliative care.MethodsWe used data from the largest German health insurance company of people over 50 years of age from the period 2014-2019. The analysis focused on the last year of life. Outcomes were outpatient and inpatient palliative care and predictors were demographics, comorbidities, therapeutic remedies and rehabilitation, care and medical interventions, medication and patient group. Combined logistic regression models and discrete conditional inference survival forests were used to predict the utilization of outpatient and inpatient palliative care. For evaluation we used concordance-index and calibration plots. We identified the most important predictors by using a permutation approach and the log-loss metric.ResultsThe study cohort for the analysis of inpatient palliative care comprised 43,896 patients, while the cohort for the analysis of outpatient palliative care included a total of 37,430 patients. The models had appropriate discriminatory power (inpatient palliative care: concordance-index = 0.737 (95%CI = 0.721-0.754); outpatient palliative care: concordance-index = 0.689; 95%CI = 0.675-0.704) and showed appropriate calibration. A diagnosis of dementia, like a diagnosis of cancer, is predictive of inpatient palliative care and outpatient palliative care. We observed a lower probability for inpatient and for outpatient palliative care for dementia patients compared to cancer patients.ConclusionsThe findings highlight the need to focus palliative care on other patient groups besides cancer patients, such as dementia patients, and to facilitate access for all patients.

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Diabetes duration and the risk of dementia: a cohort study based on German health claims data.

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Diabetes duration and the risk of dementia: a cohort study based on German health claims data.

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