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Diabetes and dementia: managing these comorbidities

Association between diabetes and dementia The prevalence of both diabetes and dementia increases with age. Consequently, many older people are living with both conditions with the median age for diabetes being 65–69 years and for dementia 80–84 years (Figures 1 and 2). Unfortunately, interaction between the two makes management of each one more complex. The risk of living with both these conditions is greater than would be expected by chance for three possible reasons: • Diabetes carries a high risk of large vessel disease, which includes the cerebral arteries. Hence vascular dementia is more common in type 2 diabetes. • Type 2 diabetes is associated with insulin resistance, which also occurs within brain tissue. Since insulin and amylin, found in the brain of people with Alzheimer’s disease, share the same metabolic pathway for their breakdown, amylin deposits are increased in the presence of insulin resistance.1 • People with diabetes (type 1 or type 2) treated with insulin, who are exposed to repeated hypoglycaemia, may be at increased risk of dementia. The evidence is conflicting, mainly because there are no longterm studies asking this question in an older population.