Hypoglycemia and cognitive decline in older people with type 2 diabetes: A bidirectional relationship

The possibility that severe hypoglycemia episodes may cause permanent damage to the brain is a source of concern for patients and their caregivers. Although studies in young adults with type 1 diabetes suggest that in general such episodes do not lead to cognitive sequelae, which is reassuring, recent data suggest that this may not be true in older patients (aged >60-70 years). Several studies in older people with type 2 diabetes show that the occurrence of severe hypoglycemia episodes increases the risk of subsequent cognitive decline and dementia. Conversely, older people with type 2 diabetes and impaired cognition are at increased risk of severe hypoglycemia episodes. This bidirectional relationship between hypoglycemia and cognitive impairment in older individuals shows that the risk-benefit ratio of intensive glycemic control is less favorable in old age. This is acknowledged by recent recommendations that advocate a more individualized approach to diabetes treatment in older patients. It is recommended that treatment goals should be fine-tuned to the preference and ability of the patient and to relevant comorbidities, including cognitive dysfunction.