A case of once-weekly basal insulin therapy for a dementia patient with Type 2 Diabetes mellitus and living alone

A BSTRACT Living alone may be one of the risk factors not only for patients with dementia, but also for dementia patients with diabetes mellitus (DM). An 89-year-old Japanese male, who lived alone visited our hospital with his daughter due to memory impairment, delusion of persecution, and diabetes mellitus. Laboratory investigations revealed a glycated hemoglobin (HbA1c: NGSP) of 11.3%. The patient was subsequently evaluated for cognitive disorders. He scored 22 points on the MMSE. Hence, visiting nursing care was introduced once per week. Furthermore, we initiated once-weekly omarigliptin therapy. Six months later, however, his HbA1c had not improved. Therefore, we changed his diabetic therapy to once weekly dulaglutide with care for appetite loss, which resulted in improvement in his HbA1c. However, since he lost 3 kg in weight, we changed his treatment back to omarigliptin in 3 months. Seven months later, since his HbA1c was increased once again, we switched back to dulaglutide once weekly with care for appetite loss. Recently, Insulin icodec has been released as once-weekly basal insulin therapy. Two months later, we changed his treatment to once-weekly insulin icodec 20 units once weekly, along with care for hypoglycemia. Omarigliptin was also added. Six months later, his HbA1c had improved to 8.0%. Once-weekly basal insulin is a potential treatment option for the diabetic patients with dementia and home visit medical treatment. Our case report emphasizes the utility of visiting nursing care and appropriate insulin dosing, using once-weekly basal insulin therapy for dementia patients with DM who live alone.