Diabetes is a global health concern associated with complications such as cognitive decline and dementia. This systematic review investigated the risk of hypoglycemia and dementia in patients with diabetes. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science for cohort studies published between January 1, 2020, and March 15, 2025. Eight studies with over 1.1 million individuals with diabetes, mainly type 2 diabetes (T2D), were included. The selected studies were conducted in various countries and had follow-up periods ranging from 5.9 to 9.14 years. This review demonstrated that hypoglycemic episodes are strongly associated with an increased risk of cognitive decline, including Alzheimers disease, vascular dementia, and all-cause dementia. The hazard ratios ranged from 1.25 to 2.80, with multiple episodes significantly increasing the likelihood of dementia. Blood sugar fluctuations, particularly increased hemoglobin A1c levels and variability, heighten the risk of dementia. Sex-based analyses showed that women with T2D faced a higher risk of dementia linked to glycemic factors. The relationship between hypoglycemia and cognitive decline is bidirectional, with cognitive decline affecting diabetes management and leading to hypoglycemia. The findings underscore the importance of maintaining stable blood sugar levels, setting treatment goals, and incorporating cognitive assessments in diabetes care for older adults.
Konda et al. (Thu,) studied this question.
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