Tight Control of Diabetes Can Ward Off MCI

Robert W. Griffith, MD

Only a week or so ago we reported a study showing that diabetes is associated with an increased risk of mild cognitive impairment or MCI - the half-way house between normal memory loss in aging and Alzheimer's disease.

Things may not be so bad as they seem for diabetics - at least type 1 diabetics. Here's the good news. Tight control of blood sugar levels is not associated with MCI. An update on a landmark study, published in the New England Journal of Medicine , reports that the progression of complications involving the eye (retinopathy), kidneys (nephropathy), nerves (neuropathy), and cardiovascular events (atherosclerosis etc.), which was reduced by intensive anti-diabetic therapy in the short term, is maintained over as least 12 years. In particular, 1144 patients had cognitive testing at enrollment and again 18 years later; there was no evidence of substantial long-term decline in cognitive function. Actually, the study was planned to answer the question "Does recurrent hypoglycemia affect long-term cognition?"

There were, in fact, relatively high rates of repeated severe hypoglycemia (episodes of low blood sugar due to the medications); 40% of the subjects had at least one such episode. The question for both patient and physician is whether the unpleasantness and risk of hypoglycemic episodes are worth the reduction in just about all diabetic complications, and the absence of cognitive decline. Most people would probably say "yes".

These results were obtained in type 1 (insulin-dependent) diabetes. It's probable, however, that they hold true for type 2 diabetics, too. Anyway, tight control of blood sugar is worth the effort, for both types.

Source
HealthandAge Blog

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