Combined Treatment with Oral Hypoglycemic Agents and Insulin in Longer Run May Lead to Cognitive Derangement Secondary to Hypoglycemia

Abstract

To determine the risk associated with combined therapy of oral hypoglycemic agents and insulin in the development of cognitive decline secondary to hypoglycemia. The study comprised of two arms, in arm 1 (n=30) diabetic patients on OHA and insulin combined therapy were observed for cognitive derangement based on Mini Cog score (Pearson’s correlation r was calculated between the two) and the patients were also ruled out for hypoglycemia episodes. Similarly, in arm 2(n=30), only OHA therapy patients were evaluated on the same parameters using Pearson’s correlation. Mean Mini Cog scores were found to be 1.79 in patients on combinational therapy of OHA and insulin. In the case of patients only on OHA for diabetes control mean Mini Cog, the score was 2.0. Pearson’s coefficient r 1 between OHA plus insulin duration of therapy in years with Mini Cog score was  -0.5831  at a statistically significant p value of 0.0007. While on the other hand, patients only on OHA therapy (in years) were not significantly correlated with Mini Cog scores.(r 2= - 0.0149 ; p value =0.93771).In the arm 1 (OHA + Insulin(n=30)), the average number of hypoglycemia episodes were found to be 2.633 as compared to the OHA only group in which mean hypoglycemia episodes were 0.866. There was a significant difference in the hypoglycemia episodes, as confirmed by the student t-test (4.06368) at a p value = 0.000147. Based on the study findings, combined Treatment with Oral Hypoglycemic agents and insulin in longer run may lead to cognitive derangement secondary to hypoglycemia.*Significance level <0.01, Negative correlations are indicative of lower the values of battery scores higher would be cognitive derangement.