Abstract
Aims
To evaluate the association between diabetes mellitus (DM) and risk of seizures in a well-defined elderly population.
Methods
The administrative databases of the Lombardy region (a 10 million population area in Northern Italy) were used to identify persons aged 65 years or older with DM (defined by prescription of antidiabetic drugs and/or through ICD-9 CM code and/or exemption code for diabetes) during the year 2002. Seizure-free DM subjects were followed until 2012 in search of individuals with incident seizures (identified through ICD-9 CM codes for epilepsy/seizures or ATC codes for antiepileptic drugs associated with the prescription of an electroencephalogram). To adjust for confounding, comorbidities having epileptogenic potential were also identified through the ICD-9 CM codes.
Results
The population at risk included 1,494,071 persons. Of these, 136,941 seizure-free patients had DM. At the end of follow-up, the cumulative time-dependent incidence of seizures was 3.0% in DM patients and 1.9% in No-diabetic individuals (hazard ratio, HR 1.47; 95% confidence interval, 1.41–1.53, adjusted for age classes, sex, comorbidities and number of hospital admission). The HR was unchanged in patients with no history of stroke. The cumulative incidence of seizures after DM increased with the number of hospital admissions.
Conclusions
DM is an independent risk factor for seizures in elderly individuals. In diabetic patients, the risk of seizures increases with the number of comorbidities, supporting the role of vascular disease as a cause of seizures.
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Acknowledgements
We thank Igor Monti from IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Simone Schiatti and Giovanna Rigotti from Lombardia Informatica S.p.A, Alfredo Bevilacqua from SANTER Reply S.p.A, and Fiorenza Clerici from IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, who kindly assisted us with data collection and secretarial activities.
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Guarantor’s name: All authors take responsibility for the contents of the article. BE, BM, RMC and TM took part in study concept and design, and interpretation of data. FI, BA and ML performed acquisition of data. VT and TM carried out analysis of data. BE, BM and RMC drafted the manuscript. All authors participated in critical revision of the manuscript for important intellectual content.
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Ettore Beghi received personal fees from Viropharma to participate in an Advisory Board, research grants from UCB-Pharma, EISAI, Shire, the Italian Drug Agency (AIFA), the Italian Ministry of Health, the American ALS Association and the Borgonovo Foundation. The other authors have nothing to declare.
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In Italy, approval from an ethics committee is not required to analyze encrypted administrative data according to the National law.
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In Italy, informed consent is not required to analyze encrypted administrative data according to the National law.
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Baviera, M., Roncaglioni, M.C., Tettamanti, M. et al. Diabetes mellitus: a risk factor for seizures in the elderly—a population-based study. Acta Diabetol 54, 863–870 (2017). https://doi.org/10.1007/s00592-017-1011-0
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DOI: https://doi.org/10.1007/s00592-017-1011-0