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Hypoglycemia Increases Risk for Dementia

Older patients with type 2 diabetes risk having dementia if their blood sugars fall way below normal according to a new study. This further ignites the controversy of whether or not diabetes patients should be treated aggressively to achieve strict blood sugar control.

The study involved 16,667 patients with type 2 diabetes enrolled in a northern California diabetes registry whose average age at study entry was 65. None of the subjects were diagnosed with dementia when they joined the study. Surprisingly, 11% of the patients were diagnosed with dementia after four years.

The study noted that older patients whose blood sugar fell so low it landed them in the hospital were found to have a 26% higher risk for dementia than patients with no history of treatment for low blood sugar. “Patients treated three or more times for hypoglycemia had nearly double the dementia risk of patients who had never been treated,” the study noted.

Having uncontrolled diabetes is associated with an increased risk for Alzheimer’s disease and other age-related dementias in elderly patients. Contrary to the notion that aggressive lowering of blood sugar would reduce this risk, the new study suggests such treatment may do more harm than good in older patients if blood sugar levels drop to dangerously low levels.

Rachel Whitmer, PhD, one of the researchers from Kaiser Permanente Division of Research in Oakland, California emphasized that understanding the impact of blood sugar on cognitive function in older patients is critical. “We are in the midst of an epidemic of type 2 diabetes and we are going to see more dementia than we have ever seen before as these patients age,” she said. “We really have to get a handle on the role of glycemic control in this.”

This study challenges the use of aggressive treatment to achieve tight glucose control in older patients. This study supports the partial findings of an ongoing trial sponsored by the National Heart, Lung and Blood Institute that is linking aggressive treatment to achieve blood sugar levels to higher risk of mortality among older patients with type 2 diabetes. For almost 3.5 years of treatment, patients in the aggressive treatment arm of the study were 22% more likely to die than patients who were not treated as aggressively.

Dr. Alan M. Jacobson, director of psychiatric and behavioral research at Harvard Medical School’s Joslin Diabetes Center said that it is clear that a better understanding of the impact of aggressive treatment on older patients with type 2 diabetes is needed. But he warns that it is too soon to change treatment, based on the research reported so far.

“It would be a mistake to throw the baby out with the bath,” he says. “We have a substantial body of research showing the benefits of improving glycemic control. But we also have to recognize that, like with any intervention, there may be a downside.”

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