Management of diabetes and dementia

Abstract

Continued advances in medicine have contributed to an ageing population in most countries, with a resultant increased prevalence of dementia as well as type 2 diabetes. Consequently, the combined co-morbidity of diabetes and dementia is on the increase. While there is a wealth of therapeutic options for diabetes in general, we need to adapt these medications and strategies to suit those with dementia. The intricacies of managing diabetes in patients with cognitive dysfunction are multiple and require a sound understanding of the patient, living environment and available therapeutic options. With the exception of metformin, dipeptidyl peptidase-4 inhibitors and to some extent insulin secretagogues, non-insulin therapy has a limited role. Insulin therapy, if initiated with a specified goal in mind and concentration on avoidance of hypoglycaemic episodes with relatively lax glycaemic targets, is the most straightforward way of managing glycaemia. Therapy should be individualised with involvement of the patient’s care team and clear instructions to define roles, goals of therapy and need for regular review. In this article we discuss the effect of dementia on diabetes management and vice versa, glycaemic goals based on available evidence and recommendations including drug and regime selection to safely achieve this. ve this.