TOPLINE:

Both type 1 diabetes (T1D) and type 2 diabetes (T2D) were associated with an increased risk for all-cause dementia, Alzheimer’s disease, and vascular dementia in a retrospective cohort study. The greatest risk was seen in T1D and insulin-treated T2D highlighting insulin-requiring diabetes as a particularly vulnerable clinical phenotype for cognitive decline.

METHODOLOGY:

• Diabetes is a well-established risk factor for cognitive decline and dementia, with the risk potentially varying by diabetes type and treatment intensity.
• Researchers conducted a retrospective cohort study using a Korean database from 2013 to 2024 to compare the risk for all-cause dementia, Alzheimer’s disease, and vascular dementia between adults with and without diabetes.
• They included 1,322,651 adults (mean age, 54.9 years; 47.6% men) without prior dementia who were stratified into four groups: those without diabetes (n = 1,203,877), those with T2D treated with oral hypoglycemic agents (n = 109,281), those with T2D treated with insulin (n = 7006), and those with T1D (n = 2487).
• Incident dementia (all-cause dementia, Alzheimer’s disease, and vascular dementia) was identified using diagnosis codes and antidementia medication prescriptions (rivastigmine, galantamine, memantine, or donepezil).

TAKEAWAY:

• Compared with individuals without diabetes, patients with T2D using oral hypoglycemic agents had a higher risk for all-cause dementia (adjusted hazard ratio [aHR], 1.29), as did patients with T2D using insulin (aHR, 2.14), and those with T1D (aHR, 2.35).
• Similar trends for the three groups were found for Alzheimer’s disease (aHRs: 1.29, 2.18, and 2.41, respectively) and vascular dementia (aHRs: 1.29, 2.23, and 2.25, respectively).
• No significant difference in the risk for dementia was found between T1D and insulin-treated T2D, suggesting that insulin-requiring diabetes represents a high-risk phenotype for cognitive decline across both types.
• Associations between diabetes and the risk for dementia were stronger among participants younger than 65 years and those without hypertension or chronic kidney disease, with the highest risk consistently seen in T1D and insulin-treated T2D across most subgroups.

IN PRACTICE:

“[The study] findings indicate that individuals with [T1D] and insulin- treated [T2D] represent a particularly vulnerable population for cognitive decline. Integrating proactive cognitive screening with optimized glycemic management — including strategies to reduce glycemic variability and hypoglycemia, such as [continuous glucose monitoring] — may help mitigate long-term dementia risk,” the authors wrote.

SOURCE:

This study was led by Ji Eun Jun, Kyung Hee University Hospital at Gangdong, and Seohyun Kim, Sungkyunkwan University School of Medicine, both in Seoul, Korea. It was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS:

The observational design of the study prevented establishing causality. Dementia was diagnosed using claims data, which may have introduced misclassification. Detailed information on diabetes severity metrics (such as A1c levels and glycemic variability) were not available.

DISCLOSURES:

The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.