Dementia and type 2 treatment should be ‘individualised’
Treatment for people who have dementia and type 2 diabetes should be focused upon and individualised for better health outcomes, researchers have said.
In a published review, entitled Management of Diabetes and Dementia, the paper also stated “clear instructions” should be given to the person’s care team so their roles are defined and the goals of therapy are set.
The work was led by Dr Amar Puttanna, who is chair of the Young Diabetologists and Endocrinologists’ Forum (YDEF) and works in the diabetes and endocrinology department for the Walsall Healthcare NHS Trust.
It was carried out because an increasing population in most countries is leading to a higher prevalence of dementia as well as type 2 diabetes. Consequently, the combined co-morbidity of diabetes and dementia is on the increase.
Although there is a wealth of therapeutic options for people who have diabetes in general, the researchers said: “We need to adapt these medications and strategies to suit those with dementia. The intricacies of managing diabetes in patients with cognitive dysfunction are multiple and require a sound understanding of the patient, living environment and available therapeutic options.”
In the article the researchers discuss the effect both dementia and diabetes management have on each other.
According to a separate report which was released by the Alzheimer’s Disease International, as of 2015 there were 46.8 million people with dementia in the world and figures are expected to rise to over 131.5 million by 2050. The report valued the cost of dementia in the UK alone amounts to more than £23 billion.
One of the main problems is that diabetes is largely a self-managed condition and prior to any dementia diagnosis, most people would be controlling their own blood glucose levels. However, once they start to decline they may forget to take medications at appropriate times and struggle to recognise hypo and hyperglycaemia symptoms.
The authors highlighted several key messages in the article which included the following:
- Awareness of pharmacological management of diabetes in dementia is important due to the various agents available and potential risks associated with each agent.
- Individualised care plans regarding therapeutic management should be planned and implemented by physicians/multidisciplinary teams to ensure safe and careful management. De-escalation of therapy should be considered to avoid overtreatment and not aiming for too tight control in those with hypoglycaemia risks and polypharmacy.
- When considering oral therapy, agents such as metformin, DDP-4 inhibitors and rapid insulin secretagogues are beneficial.
- SGLT-2 inhibitors, GLP-1 agonists and high dose sulfonylureas are probably best avoided due to side effects that have specific implications in patients with dementia.
- When considering insulin, long-acting insulin in combination with oral therapy or insulin therapy on its own is recommended.
- Regular assessment of patient understanding and administration should take place and a responsible healthcare professional should be tasked with reviewing whether the current regimen is appropriate.