Diabetics face the daily issue of controlling their insulin levels to avoid extreme high and low blood sugar, which is known to be detrimental to overall health. Medical data clearly links type 2 diabetes with the possibility of heart attack and stroke, and a study published in the April 15 issue of the Journal of the American Medical Association connects the disease to increased risk of dementia.
Those most affected, according to the study, were older individuals who have had severe levels of low blood sugar that required hospitalization or emergency room visits. The risk to patients with less severe episodes of low blood sugar, common to most diabetics, was not clear. Rachel A. Whitmer, study author, of Kaiser Permanent in Oakland, California was quoted as saying “Hypoglycemic episodes that were severe enough to require hospitalization of an emergency room visit were associated with greater risk of dementia, particularly for those patients who had multiple episodes. And these findings, a little bit to our surprise, were independent of glycemic control.” She also associated hypoglycemia with neurologic consequences in patients already at risk for dementia. The evidence of glycemic control is critical particularly for older diabetics.
The study covered 16,667 patients, average age 65 from 1980 to 2007, all with type 2 diabetes. Hypoglycemic episodes were recorded over 22 years and more than four years were used for follow up dementia diagnoses.
Dr. Nir Barzilai, director of the Institute for Aging Research at Albert Einstein College of Medicine and the Montefiore Hospital Diabetes Clinic in New York City said that the study is by association only and there is no proof of cause and effect link between the two conditions. “It could be fluctuation of glucose. We know that hyperglycemia (high blood sugar) is also very toxic to the cells. All those things cannot be dissected on a study like this.”
Whitmer noted that hypoglycemia is probably not the only reason for the increased risk of dementia in those with type 2 diabetes, but that people with type 2 diabetes are at 32 percent greater risk of dementia. People with pre-diabetes also have greater risk.
Previous studies have linked type 1 diabetes with cognitive impairment in children and adults. The same mechanism could apply to older adults with type 2 diabetes or there could be some other underlying condition.
The study would indicate that blood-sugar control is the strategy to prevent damage, but according to medical experts it is difficult to maintain and monitor and the use of insulin does not bring instantaneous adjustment. Barzilai said, “You give them a little bit of insulin, and they get hypoglycemia. You give them a little less, the glucose goes very high. It’s individual. It’s not that you know what to do with every patient.” Michael Horseman, associate professor of pharmacy practice at the Texas A & M Health Science Center said, “There hasn’t been a study that I’m aware of where they made a serious attempt to keep blood sugar in the normal range that didn’t have episodes of hypoglycemia.”
There are approximately 23.6 million Americans with diabetes and Alzheimer’s disease, the most common form of dementia in older people, affects 5.2 million people. Neither diabetes nor Alzheimer’s has a cure. Those who do not currently suffer from diabetes need to be proactive with their own health. The Mayo clinic website has 5 tips to preventing diabetes:
Discuss your risk factors with your health professional and take charge of your future.