AI Insight
This nationwide Spanish study analyzed 2.8 million hospitalizations of patients with type 2 diabetes between 2021 and 2024, finding that 6.48% involved dementia diagnoses, with Alzheimer's disease being most common (2.88%) followed by vascular dementia (1.44%). Hospitalizations involving dementia had higher mortality rates (17.06% vs 7.22%), lower ICU admission rates, and higher palliative care utilization compared to those without dementia, with women showing lower adjusted odds of in-hospital death despite higher dementia prevalence. Prior stroke or transient ischemic attack was strongly associated with vascular dementia, showing a nearly six-fold increased odds.
Why it matters
These findings highlight critical sex disparities and clinical outcomes in patients with comorbid diabetes and dementia, informing resource allocation and care planning in hospital settings. The strong association between stroke history and vascular dementia emphasizes the importance of stroke prevention in diabetic patients to potentially reduce dementia risk.
Understand the Science
by Natividad Cuadrado-Corrales, Diana María Mérida, Ana Lopez-de-Andres, Jose J. Zamorano-Leon, Rodrigo Jimenez-Garcia, David Carabantes-Alarcon, Andres Bodas-Pinedo, Valentin Hernandez-Barrera, Lucia Fuentes-Arroyo
Background
The co-occurrence of type 2 diabetes mellitus (T2DM) and dementia represents a major public health challenge in Spain, where prevalence among hospitalized patients rose from 6.9% in 2011 to 10.6% in 2020. However, post-pandemic trends and sex-specific clinical outcomes remain under-characterized. We aimed to evaluate the frequency and temporal trends of dementia subtypes, clinical profiles, and predictors of in-hospital mortality (IHM) among T2DM-related hospitalizations in Spain (2021–2024).
Methods
We conducted a nationwide retrospective observational study using the Spanish National Hospital Discharge Database (RAE-CMBD) and analyzed 2,786,184 T2DM-related hospital discharge episodes recorded between 2021 and 2024. The unit of analysis was the hospitalization episode rather than the unique individual; therefore, recurrent admissions for the same person could be included as separate observations. Multivariable logistic regression identified independent predictors of dementia presence and IHM.
Results
All-cause dementia was coded in 180,623 hospital episodes, corresponding to 6.48% of T2DM-related hospitalizations. This proportion was higher among hospitalizations involving women than among those involving men. Regarding specific subtypes, AD was the most frequent diagnosis with 80,174 cases (2.88% prevalence), presenting an IHM of 16.3% across the study period. VaD affected 1.44% of the sample. A remarkably strong association was found between prior stroke/TIA and the presence of VaD (aOR 5.89; 95% CI 5.69–6.09). Hospitalizations involving all-cause dementia had higher in-hospital mortality (17.06% vs. 7.22%), lower ICU admission rates (1.33% vs. 7.58%), and higher frequencies of palliative-care coding (3.76% vs. 1.65%) than hospitalizations without dementia (Table 3). They also had shorter hospital stays and lower median estimated hospitalization costs (€6,129.3 vs. €8,602.94). A comprehensive breakdown of in-hospital mortality according to specific concomitant conditions and dementia status is available in S3 Table.
Conclusions
Among T2DM-related hospitalizations with dementia, female sex was associated with lower adjusted odds of in-hospital mortality. Prior stroke or transient ischemic attack was strongly associated with vascular dementia coding. Lower ICU admission and higher palliative-care coding were observed among hospitalizations involving dementia; however, the clinical reasons underlying these patterns cannot be determined from administrative discharge data.