Severe hypoglycaemia associated with cognitive damage

Lee AK, Rawlings AM, Lee CJ et al (2018) Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study. Diabetologia 61: 1956–65

• Research has demonstrated that the presence of diabetes can increase a person’s risk of developing Alzheimer’s disease and vascular dementia, possibly due to microvascular damage reducing blood flow to the brain, however this association has not been clearly characterised.
• Researchers evaluated the link between severe hypoglycaemia and brain volume, cognitive decline and dementia in 2,001 people with type 2 diabetes participating in the Atherosclerosis Risk in Communities (ARIC) cohort study. 
• Between baseline (1996–8) and follow up (31 December 2013), 3.1% of participants experienced severe hypoglycaemia, which was identified using ICD-9 codes.
• Compared to normal cognitive status, severe hypoglycaemia was found to be associated with dementia (odds ratio 2.34; 95% confidence interval [CI] 1.04–5.27). 
• Hypoglycaemia was nominally associated with cognitive change over 15 years (95% CI -0.34–0.06), was strongly associated with incident dementia (95% CI 1.78–3.63), and was associated with smaller brain volume (CI -0.612–0.004).
• There is a strong link between severe hypoglycaemia and poor cognitive outcomes, which has implications for high-risk older adults with diabetes. 

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