To fully implement existing guidelines for cognitive dysfunction in diabetes into everyday practice, clinicians must tailor screening strategies and treatment plans to the individual patient, according to a review published in Diabetologia.

Previous studies have brought to light the importance of cognitive dysfunction in patients with diabetes, with an increasing number of available guidelines addressing cognition. In this review, researchers summarized the manifestations of cognitive dysfunction in adults with diabetes and their impact on care, as well as steps required to best implement guidelines for these patients.

Evidence to date suggests that the risk for all-cause dementia is 40% to 60% higher in patients with type 1 or type 2 diabetes. The risk for mild cognitive impairment is 20% higher in patients with type 2 diabetes, but no data are available regarding the risk in patients with type 1 diabetes. Subtle cognitive decrements, defined as deviation from normal cognitive functioning but not severe enough to be classified as cognitive impairment, are relatively common in patients with type 1 or type 2 diabetes.

Age, poor glycemic control, hypoglycemic and hyperglycemic events, depression, and vascular complications are all associated with increased risk for dementia in patients with type 2 diabetes and worse cognitive performance in both type 1 and type 2 diabetes. There is no evidence that intensified glycemic control can preserve cognitive functioning.

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While in the general population screening for cognitive impairment is generally not recommended, in patients with diabetes early detection may improve diabetes management. As screening all people with diabetes for cognitive impairment would be quite a challenge, existing guidelines advise assessing patients over the age of 60 to 65 years or implementing individualized strategies for screening based on risk factors beyond age. Healthcare professionals should determine the optimal screening test and frequency to improve patient outcomes and should follow a reliable and efficient diagnostic protocol for patients who screen positive.

Current guidelines also include recommendations for the treatment of people with diabetes and cognitive impairment, which are based primarily on expert opinion. Developing a personalized approach for diabetes care beyond glycemic control is recommended, taking into consideration how cognitive impairment affects the patient and caregivers. It is also important to develop diabetes treatment regimens that are safe and feasible for those with cognitive impairment.

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Reference

Biessels GJ, Whitmer RA. Cognitive dysfunction in diabetes: how to implement emerging guidelines [published online August 16, 2019]. Diabetologia. doi:10.1007/s00125-019-04977-9