Elderly patients with diabetes may suffer from a dangerous cycle of hypoglycemia (abnormally low blood sugar ) and dementia, according to a new US study.
The research, published online in JAMA Internal Medicine, found that older diabetic patients are at greater risk of dementia if they suffer severe hypoglycemia, and in turn, are more likely to have subsequent hypoglycemic events (hypos) if they develop dementia.
To examine the relationship between hypoglycemia and dementia, researchers from the University of California San Francisco examined data on almost 800 older adults with an average age of 74 years. Each person had diabetes but no cognitive impairment at baseline. It was not specified whether patients had type 1 or type 2 diabetes.
During 12 years of follow up, 61 (7.8%) individuals experienced a severe episode of hypoglycemia and 148 (18.9%) individuals developed dementia. Of those who suffered a severe hypo, more than a third (34.4%) developed dementia, compared with 17.6% of patients who didn’t have a reported hypoglycemic event.
After adjusting for multiple confounders including age, sex, ethnicity, insulin use, blood sugar levels and baseline cognitive function, the researchers found that the risk of dementia was twice as high among those who had a severe hypo, compared with those who did not.
Similarly, the risk of a subsequent severe hypo was about three times greater for elderly diabetic patients who’d developed dementia.
“Our results provide evidence for a bidirectional association between severe hypoglycemia and dementia,” the authors wrote.
“Hypoglycemia may impair cognitive health, and reduced cognitive function may increase the risk for a hypoglycaemic event that could further compromise cognitio, resulting in a detrimental cycle.”
They concluded that cognitive function should be considered in the clinical management of older patients with diabetes.

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