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Hypoglycemia a Risk Factor for Cognitive Decline in Type 2

Elderly type 2 diabetic patients particularly vulnerable…. 

Type 2 diabetes is associated with an increased risk of cognitive impairment, cognitive decline, and dementia. Because there is an increasing number of elderly type 2 diabetic patients, prevention of cognitive decline is important. Studies have been done in individuals with type 1 diabetes in which hypoglycemia has been associated with lower cognitive ability in children, but not adults. Type 2 diabetic patients are also known to have episodes of hypoglycemia, particularly adults and patients treated with sulfonylureas. Because the population of type 2 diabetics are predominantly adults, it warranted the need for this type of study.

The Edinburgh type 2 diabetes study looked at a sample of 1,066 subjects with type 2 diabetes aged 60-75 years in 2006-2007. A total of 831 subjects returned for a follow-up four years later in 2010-2011. Using a questionnaire, the subject’s history of hypoglycemia episodes was assessed at baseline and at year 4. Cognitive assessment was also performed which tested verbal, nonverbal, processing, and working memory, as well as nonverbal reasoning. Results showed subjects with a history of hypoglycemia had a lower performance on the cognitive assessment compared with the rest of the subjects. A history of hypoglycemia was associated with a steeper decline in cognitive function as well.

In conclusion, severe hypoglycemia was associated with a steeper decline in cognitive function. Thus, hypoglycemia is a risk factor for cognitive decline. There is evidence that shows that people with poor cognitive ability may be more susceptible to hypoglycemia. This make be because people with lower cognitive ability are less able to recognize the signs and symptoms of hypoglycemia and are therefore unable to treat it as it occurs or prevent it from happening through appropriate diabetes management. Despite these findings, it is unknown if there is a causal effect between the two.

Clinical Pearls:
  • There is an association between severe hypoglycemia and a decline in cognitive function, though a causal link between the two has not been established.
  • Type 2 diabetics should be monitored for and educated about hypoglycemia and its signs and symptoms. 

Feinkahl, I. et al. "Severe Hypoglycemia and Cognitive Decline in Older People With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study" Diabetes Care. 2014;37(2): 507-515