Type 1 Diabetes Linked With Increased Dementia Risk
A recent metanalysis found that patients with type 1 diabetes had a 50% higher chance of developing dementia.
Patients with type 1 diabetes (T1D) are at an increased risk of dementia, according to new data published in the journal Diabetes Research and Clinical Practice.1 The authors of the study said that the findings support incorporating more routine cognitive screening for patients with T1D as they progress into older age.
Type 1 Diabetes Linked With Increased Dementia Risk / sulit photos - stock.adobe.com
According to data from the American Diabetes Association, 2 million people in the country have T1D, including about 304000 children and adolescents.2 Previous research has found that T1D is associated with an increased risk of dementia, due possibly to lack of glycemic control and other comorbidities. However, findings from across different cohorts have been inconsistent and have never been integrated.
READ MORE: Digital Education Games Could Help Improve Diabetes Management in Children
“There is increasing recognition that Alzheimer’s disease dementia biomarkers may be elevated in individuals with T1D,” the authors wrote. “Specifically, studies have identified higher cerebrospinal fluid levels of β-amyloid and phosphorylated Tau protein in this population. These biomarkers are commonly observed in individuals with mild cognitive impairment and are known predictors of neurodegenerative progression to Alzheimer’s disease dementia.”
Investigators from La Trobe University in Melbourne, Australia conducted a study to quantify the association between T1D and dementia, including subtypes. Data for the systematic review and metanalysis was collected from a search of CINAHL, EMBASE, MEDLINE, PSYCINFO, and Web of Science through August 2023. Studies were included if they reported prevalence or incidence of dementia in patients with T1D.
The systematic review included a total of 19 studies across 10 different cohorts published from 2010 to 2023. The studies took place in Denmark, Finland, Sweden, Taiwan, the United Kingdom and the United States. Sample sizes ranged from 18 patients to 343062, with a mean age from 37 to 81 years. Of the studies, 17 reported on dementia incidence, 1 reported on prevalence, and 1 reported on incidence and prevalence.
The studies found that patients with HbA1c levels of 8 to 8.9% and 9% or higher had a 65% and 79% higher risk of dementia, respectively. One study also showed patients with HbA1c levels between 6 and 7.9% had a 45% lower risk of dementia. For subtypes, 8 studies reported a higher risk of Alzheimer's disease, 6 reported a higher risk of vascular dementia, and 3 reported a higher risk of mixed or other dementia.
Additionally, in the metanalysis, 5 studies with a total of 29105 patients reported that patients with T1D had a 50% higher chance of developing dementia compared to patients without the disease.
Study limitations included significant heterogeneity among the included studies, that the studies did not adjust for important confounding variables, that findings are limited due to the exclusion of non-English publications, and that all of the studies from the US were from the KPNC Diabetes Registry, which may not be truly representative of the general population in the country.
“Our findings have important implications for both research and clinical practice,” the authors concluded. “Clinicians could consider incorporating dementia risk assessment, via routine cognitive screening for people with Type 1 diabetes as they transition into older adulthood, with more vigilant screening for those with co-morbidities known to also increase dementia risk. Cognitive strategies for memory, attention, and executive functioning, that promote and support activity and participation, are also recommended.”
READ MORE: Diabetes Resource Center
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