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Diabetes and Its Association with Dementia

Individuals with diabetes who experience hypoglycemia at increased risk for developing cognitive dysfunction and dementia.

Diabetes is often a common risk factor to the development of various comorbidities, including cardiovascular morbidity and mortality. It is also known that cardiovascular disease is the major cause of death among individuals with diabetes. However, recent findings also suggest that diabetes has been linked to the development of dementia and other cognitive dysfunctions. This prevalence of neurodegenerative diseases has been steadily rising over years. In a recent article review, titled “Hypoglycemia and Dementia,” authors aim to discover factors influencing the link between diabetes and dementia by observing several studies conducted throughout the years.

The exact mechanism by which diabetes causes dementia and other cognitive dysfunction is yet to be determined. However, other plausible factors like hypoglycemia play an important role in the development of dementia. Diabetes can lead to dementia by decreasing the threshold of amyloid plaques required in brain tissue. Furthermore,  the increased risk of microvascular complications associated with diabetes can increase the risk of vascular dementia. Moreover, insulin resistance and hyperinsulinemia are also known to be major risk factors by causing an accumulation of amyloid-B (AB) proteins and hyperphosphorylating tau proteins. The mechanism by which this ensues is through advanced glycation of end products from hyperglycemia, which in turn induce the glycation of AB and tau proteins resulting in dementia. In addition to this, oxidative stress and low-grade inflammation also play a role in dementia via AB metabolism.

The data and results of three studies were examined for accuracy between the link of diabetes and dementia. In one study, relative risk ratios were determined for the development of Alzheimer’s disease and vascular dementia among diabetes patients. The relative risk for Alzheimer’s disease was 1.56 (95% CI) and the relative risk for vascular dementia was 2.27 (95% CI). These observations were made among people with and without diabetes. In a study conducted in Korea on 1,957 adults 60 years or older without a history of severe hypoglycemia, the relative risk of dementia and vascular dementia were 1.4 (95% CI) and 2.8 (95% CI), respectively. Moreover, in one retrospective study, including 16,667 elderly diabetes patients, the risk of dementia increased by 26% with a hazard ratio of 1.26 and a 95% CI. Furthermore, in that same retrospective study, morbidity and mortality rate of patients with diabetes and dementia were reported to be twice as high as non-diabetes-diagnosed patients with dementia  (hazard ratio, 1.9; 95% CI, 1.3 to 2.9). Results of the above study emphasize that the risk of dementia increases significantly with increasing hypoglycemic episodes.

In the Korea National Diabetes Program (KNDP) cohort study, hypoglycemia was the major clinical condition observed during the treatment of diabetes patients. The incidence of hypoglycemia in diabetes patients under the age of 50 was observed to be 3.72 cases per 1,000 person-years. This prevalence of hypoglycemia steadily increased with age, reaching 15.75 cases per 1,000 persons in elderly individuals. Many studies have shown that hypoglycemia can negatively impact a diabetes patient’s clinical course and treatment. The impact to which hypoglycemic episodes occur and the duration they last may lead to hypoglycemic encephalopathy. In addition to hypoglycemia, factors like multiple comorbidities, under-nutrition, and polypharmacy also contribute significantly to major cognitive dysfunction.

Strategies to reduce hypoglycemic events in diabetes patients have been formulated to include flexible blood glucose control among individuals with diabetes as opposed to more strict controls. Appropriate blood glucose control can help ensure positive clinical outcomes and prognosis among diabetes patients. In addition to this, regular healthy eating habits and exercise are major contributors to positive outcomes in diabetes and cognitive impairment. Moreover, the use of anti-diabetes medications with low hypoglycemic events are also important to the overall health and well being of individuals with diabetes.

It is evident that hypoglycemia is a condition experienced by many people with diabetes. However,  the need to reduce the amount and severity of hypoglycemic episodes is not only warranted but necessary. If left untreated, hypoglycemia can negatively impact the life of a person with diabetes and increase the likelihood of cognitive impairments ultimately leading to disease states like vascular dementia and Alzheimer’s disease. It is imperative that individualized therapeutic approaches are taken in the treatment of people with diabetes. Goals to control blood glucose levels, maintain proper medication usage, apply healthy eating habits and lifestyles, and monitoring comorbidities associated with one’s diabetes state are a few of many ways to the prevention of other future complications.

Practice Pearls:

  • Diabetes is the leading cause of various chronic disease states, including dementia and Alzheimer’s disease.
  • The number of hypoglycemic episodes and the duration of each can negatively impact outcomes in a person with diabetes.
  • Hypoglycemia, poor medication usage, and multiple co-morbid states associated with diabetes can increase the likelihood of dementia.

Rhee, Sang Youl. “Hypoglycemia and Dementia.”Https://doi.org/10.3803/EnM.2017.32.2.195. N.p., n.d. Web. 12 July 2017.

Ravona-Springer, Ramit, and Michal Schnaider-Beeri. “The association of diabetes and dementia and possible implications for nondiabetic populations.” Expert review of neurotherapeutics. U.S.  National Library of Medicine, Nov. 2011. Web. 12 July 2017.

Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy