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Diabetic Hypoglycemia - an independent electronic journal dedicated to the advancement of hypoglycemia research and clinical management
Diabetic Hypoglycemia Volume 6, Issue 3, January 2014

Spotlight Article

Hypoglycemia and cognitive decline in older people with type 2 diabetes: a bidirectional relationship

Geert Jan Biessels

Diabetic Hypoglycemia January 2014, Volume 6, Issue 3: page 11-14

The possibility that severe hypoglycemia episodes may cause permanent damage to the brain is a source of concern for patients and their caregivers. Although studies in young adults with type 1 diabetes suggest that in general such episodes do not lead to cognitive sequelae, which is reassuring, recent data suggest that this may not be true in older patients (aged >60–70 years). Several studies in older people with type 2 diabetes show that the occurrence of severe hypoglycemia episodes increases the risk of subsequent cognitive decline and dementia. Conversely, older people with type 2 diabetes and impaired cognition are at increased risk of severe hypoglycemia episodes. This bidirectional relationship between hypoglycemia and cognitive impairment in older individuals shows that the risk-benefit ratio of intensive glycemic control is less favorable in old age. This is acknowledged by recent recommendations that advocate a more individualized approach to diabetes treatment in older patients. It is recommended that treatment goals should be fine-tuned to the preference and ability of the patient and to relevant co-morbidities, including cognitive dysfunction.


Keywords: dementia, diabetes, hypoglycemia