WASHINGTON – Improved management of patients with type 1 diabetes and the resulting increased longevity it has fostered has produced a new medical concern that few patients faced in the past: their risk for developing dementia as they age into their 60s, 70s, and beyond.
That risk, which turns out to be nearly double that of people without diabetes, closely matches the higher risk faced by patients with type 2 diabetes, based on analysis of data collected during 2002-2014 from more than 490,000 people aged 60 years or older enrolled in the Kaiser Permanente Medical Care Program of Northern California, Rachel Whitmer, Ph.D. reported at the Alzheimer’s Association International Conference 2015.
Her study tracked the dementia incidence in 334 of these Kaiser Permanente enrollees with type 1 diabetes and no dementia at baseline and found the rate ran 73% higher when compared with controls without any type of diabetes in the cohort after adjustment for sex, race, and vascular complications such as hypertension, stroke, and peripheral vascular disease. The patients with type 1 diabetes averaged 71 years old at baseline and their follow-up averaged 7 years. This is the first study to look at the incidence of dementia in elderly patients with type 1 diabetes, Dr. Whitmer said in an interview during the meeting.
Physicians who care for patients with type 1 diabetes should be aware of this increased risk, be on the lookout for signs of developing dementia in these patients, and use the increased risk to help motivate type 1 diabetes patients to be vigilant in controlling their disease to help avoid the microvascular complications that likely contribute to their dementia risk. Patients with type 1 diabetes are especially vulnerable to the consequences of cognitive impairment as they must maintain complex self-management routines of blood glucose monitoring, insulin administration, and keeping close tabs on their diet and exercise, Dr. Whitmer noted.
In 2013, she and her associates published a simple and easy-to-use tool for clinicians to assess the dementia risk in individual patients with type 2 diabetes (Lancet Diabetes Endocrinol. 2013;3:183-90). Further study of the risk factors that contribute to dementia onset in patients with type 1 diabetes will hopefully lead to creation of a similar risk-assessment tool for use in type 1 patients, said Dr. Whitmer, an epidemiologist at the Kaiser Permanente Northern California Division of Research in Oakland.
Dr. Whitmer had no disclosures.