Identification of Undetected Dementia and Hypoglycemic Risk Using the Dementia Assessment Sheet for Community-Based Integrated Care System 21-Items in the Glycohemoglobin-Guided Management of Elderly Individuals with Diabetes: An Exploratory Study

Background: Assessing cognitive function and the risk of hypoglycemia among older individuals with diabetes is an ongoing challenge. Although the Japan Diabetes Society/Japan Geriatrics Society Joint Committee has already provided recommendations for glycemic control in older individuals with diabetes, its usefulness in clinical settings remains unclear. Methods: A retrospective, single-center study was conducted on 616 outpatients aged over 65 years at Osaka Red Cross Hospital, Japan. They were assessed for glycemic control and cognitive function using the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21). Patients were categorized into three groups based on cognitive function, and each group was divided into six subcategories based on recommended therapeutic regimens. Results: Ninety-eight patients treated with insulin, sulfonylurea, or glinide were identified using DASC- 21 and classified into categories IIB and IIIB. The number of hypoglycemic events was divided according to the lower limit of the recommended glycohemoglobin (HbA1c) value. However, the results did not significantly differ. Notably, in 7 of 9 IIIB patients who with hypoglycemic events, their DASC-21 scores reached up to 36. This suggests that the physicians had not identified the risk of dementia before conducting the assessment using DASC-21, which might result in continuous therapy for diabetes including daily multiple insulin injections. Conclusions: Physicians can overlook the risk of hypoglycemia and cognitive impairment thereby failing to optimize diabetic therapies among older individuals if DASC-21 is not used during assessments in daily diabetic care.