Evidence map›Paper›PMID 38272546›Full record

ArticleBMJ open2024

Clinical characteristics and healthcare utilisation associated with undiagnosed cognitive impairment in elderly patients with diabetes in a primary care setting: a population-based cohort study.

Eugene Merzon, Miriam Shpigelman, Shlomo Vinker, Avivit Golan Cohen, Ilan Green, Ariel Israel, T Cukierman-Yaffe, Roy Eldor

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.4field-weighted citation impact, top 43% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Eugene MerzonMedical Division, Leumit Health Care Services, Tel Aviv, Israel.ORCID 0000-0001-5469-0236
Miriam ShpigelmanClalit Health Services, Dan Petach Tikva, Israel.
Shlomo VinkerMedical Division, Leumit Health Care Services, Tel Aviv, Israel.
Avivit Golan CohenMedical Division, Leumit Health Care Services, Tel Aviv, Israel.
Ilan GreenMedical Division, Leumit Health Care Services, Tel Aviv, Israel.
Ariel IsraelMedical Division, Leumit Health Care Services, Tel Aviv, Israel.
T Cukierman-YaffeDivision of Endocrinology, Diabetes and Metabolism, Gertner Institute, Sheba Medical Center, Ramat Gan, Israel.
Roy EldorDiabetes Units, Institute for Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel eldorroy@yahoo.com.ORCID 0000-0002-1151-1370
Tel Aviv University · ILClalit Health Services · ILAriel University · IL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe objective of this study is to report the prevalence, clinical characteristics and healthcare utilisation of patients with type 2 diabetes (T2DM) and previously undiagnosed cognitive impairment who were identified as having a low Montreal Cognitive Assessment (MoCA) score.

designA population-based cohort study comparing clinical characteristics, medications, outpatient and inpatient care of patients with a MoCA score <19 to MoCA >26 using descriptive statistics, linear regression and multivariate logistic regression.

settingElectronic medical records of a large health maintenance organisation in Israel.

participants350 patients, age >65 with T2DM who participated in a cognitive function screening initiative using MoCA, and had a follow-up visit during the 12 months after screening.

results130 (37.1%) had a MoCA score >26 and 68 (19.4%) <19. Patients with MoCA<19 had more diabetes-related complications, poorer glycaemic and lipid control, fewer visits to their main primary care physician (PCP; 3.9±3.2 vs 7.3±4.2 visits/year p=0.008), shorter duration of PCP visits (8.3±4.5 vs 4.0±3.5 min, p=0.007), fewer nutritionist and endocrinologist visits, and lower participation in diabetes or smoking cessation workshops. They were less likely to be treated with glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 inhibitor (DPP-4), or sodium-glucose transport protein 2 (SGLT-2) inhibitors and more likely to receive insulin or sulfonylurea. Moreover, they had more emergency room visits (ER; 15 (11.5%) vs 16 (23.5%), p=0.019), hospitalisations (8 (6.2%) vs 22 (32.4%), p=0.001), and longer hospital stays (4.3±3.2 vs 14.5±9.8, p=0.001). Using statistical models, MoCA<19 was identified as a risk factor for fewer and shorter PCP visits and more ER visits and hospitalisations.

conclusionsThis study highlights the high prevalence of undiagnosed severe cognitive impairment in elderly patients with T2DM and its association with poor outpatient care. Appropriate interventions are needed to improve outcomes and prevent hospitalisation in this high-risk population.

Indexed as

Cognitive DysfunctionDiabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsAgedChild, PreschoolCohort StudiesHumansHypoglycemic AgentsPatient Acceptance of Health CarePrimary Health CareDipeptidyl-Peptidase IV InhibitorsHypoglycemic AgentsAgedDementiaGeneral diabetesPrimary Health Care

Identifiers

PMID38272546
PMCPMC10824016
OpenAlexW4391234899

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.