The National Health Services conducted a study focusing on the frequency of cognitive disorders and their influence on the progression of diabetes. The study, which has been published in the medical periodical BMJ, found that diabetes patients who also exhibited cognitive impairments had higher blood sugar levels, a less optimal management of their diabetes, and a less favorable control of associated conditions like hyperlipidemia.
These patients also experienced a higher incidence of additional diabetes-related complications, such as leg ulcers or the need for leg amputation.
Within the scope of the study, cognitive evaluations (using the MoCA test) were performed on 350 patients. The aim was to identify differences between diabetes patients with a normal cognitive state and those diagnosed with cognitive impairments. It was found that 37% of the participants had a normal cognitive state, 43% demonstrated cognitive decline, and 20% were diagnosed with severe cognitive deterioration. The patients were previously unaware of their cognitive deficits and hadn't been diagnosed prior to this study.
The research also revealed that patients with less controlled diabetes had fewer visits to their family doctors and dietitians, and a higher rate of hospital admissions and emergency room visits. In addition, a connection was observed between the quality of healthcare received and the patient's cognitive state. Those with cognitive impairments were less likely to be prescribed advanced diabetic medications, despite these new drugs being more efficient, offering protection to the heart and kidneys, and in some cases, aiding in weight loss.
The researchers assumed that these patients made fewer visits to their family doctor due to increasing difficulties in self-care. Moreover, due to the complexity of new treatments and the challenge in explaining and implementing changes in medication among these patients, doctors tended to continue with existing treatments rather than switching to more advanced treatment.
Diabetes cases have been increasing both in Israel and worldwide. According to statistics from the Ministry of Health, diabetes affects over 10% of the population. There are many potential complications for those living with diabetes, including an increased likelihood of heart and vascular diseases, strokes, and more. Among these, a deterioration in memory and cognitive capabilities is a less recognized but constitutes a significant complication. The probability of dementia in a diabetes patient can be as much as 60% higher than in non-diabetic individuals. The main causative factors are likely a reduction in cerebral blood flow due to vascular damage and the detrimental effects of high blood sugar levels on the brain.
The management of diabetes can be complex, requiring multiple medications administered at different intervals throughout the day, injectable medications, adherence to a low-sugar diet, and regular check-ups. Therefore, any cognitive decline can potentially disrupt the management of the disease.
The study underscores the need to heighten awareness around cognitive decline as a risk factor for complications and less than optimal treatment in diabetes patients. The primary takeaway from the research is the importance of investigating and diagnosing cognitive decline in diabetes patients if it's suspected. It's crucial to find solutions that enable optimal treatment, such as enlisting the aid of family members or arranging for nursing care, where a caregiver can assist the patient at home. Furthermore, it's vital to devise a treatment plan that's easy to understand and follow to accommodate these patients.
- Dr. Ilan Green is head Of department at Leumit Health Services