Severe Hypoglycemia in Type 2 Diabetes Linked to Poor Cognitive Outcomes

Low blood sugar level on glucometer
Low blood sugar level on glucometer
Adjustment of glucose-lowering medications in patients who are at high-risk for severe hypoglycemia may be beneficial to prevent mild cognitive impairment.

Severe hypoglycemia in older adults with diabetes is associated with poor cognitive outcomes and a higher risk for subsequent dementia, according to findings published in Diabetologia.

Hypoglycemia has been associated with short-term cognitive effects such as confusion and cognitive difficulties, and while symptoms tend to improve as blood glucose levels normalize, there has been concern about residual damage. However, it remains unclear whether recurrent episodes of hypoglycemia will eventually result in permanent brain damage.

In this study, the investigators evaluated the link between severe hypoglycemia and domain-specific cognitive decline, smaller brain volume, and dementia in a cohort of adults with diabetes who participated in the community-based Atherosclerosis Risk in Communities (ARIC) study. Of 2001 participants with a mean age of 76, 3.1% had a history of severe hypoglycemia and associated dementia (vs normal cognitive status: odds ratio, 2.34; [95% CI, 1.04-5.27]). Of the 580 participants who had undergone a brain magnetic resonance imaging (MRI) scan, the presence of hypoglycemia was associated with smaller total brain volume (−0.308 standard deviation [SD]; 95% CI, −0.612 to −0.004). Hypoglycemia was also nominally associated with a 15-year change in cognition (−0.14 SD; 95% CI, −0.34 to 0.06). The researchers also conducted a prospective analysis (n=1263) that showed a strong association between hypoglycemia and incident dementia (hazard ratio, 2.54; 95% CI, 1.78-3.63).

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“Careful consideration of baseline cognitive function is warranted in future analyses of hypoglycemia and cognitive decline and dementia,” the investigators wrote. These findings suggest the need for discussing appropriate interventions in this population.


Lee AK, Rawlings AM, Lee CJ, et al. Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study [published online June 30, 2018]. Diabetologia. doi:10.1007/s00125-018-4668-1