Multidisciplinary Diabetes Management May Lead to 28% Lower Dementia Risk, According to New Research

Did you know that diabetes can increase the risk of dementia? Scientists aren’t exactly sure why, and there may be several reasons. For example, high levels of sugar in the blood can damage blood vessels—including those in the brain. Damaged blood vessels mean reduced blood flow, which can lead to nerve damage—and this can result in various forms of dementia. 

There is also evidence that shows that the younger you’re diagnosed with type 2 diabetes, the greater your risk of dementia. For example, one study we previously reported on showed that a type 2 diabetes diagnosis before age 60 was linked to a 300% increased risk of dementia. Those who were diagnosed between ages 60 and 69 had a 73% increased risk, and people with a type 2 diagnosis between 70 and 79 were at 23% higher risk for dementia.

A new study, though, shows promise for reducing the risk of dementia for those with type 2 diabetes. 

How Was the Study Conducted?

The large cohort longitudinal study, published on February 12, 2024, in JAMA Network Open, compared people with diabetes who had voluntarily joined the public health program called Risk Assessment and Management Program-Diabetes Mellitus (RAMP-DM), to people with diabetes who had not joined the program.

The study included a total of 55,618 people with an average age of 68. Each person had diabetes for an average of about six years. The data was drawn from medical records spanning eight years—from 2011 to 2019. 

The RAMP-DM group received multidisciplinary care that included a team of medical providers. The other group acted as the control group and received “usual care.” 

Usual care included seeing their primary care physician every two to four months. The PCP performed physical examinations, prescribed and adjusted medications, and referred these patients to specialists as needed. 

The RAMP-DM group received usual care plus a host of other benefits. Their care team included physicians, nurses and allied health professionals, including registered dietitians. Participants in this group received assessments of lifestyle behaviors and medication adherence, screenings for diabetes complications and estimation of cardiovascular risks. They also received health education and general guidance for diabetes management. 

The risk factors the RAMP-DM group was screened for included smoking status, obesity, high blood pressure, high cholesterol and triglycerides, diabetic retinopathy (an eye condition that results in loss of vision or blindness), albuminuria (protein in the urine that is a sign of kidney disease), foot problems and estimated glomerular filtration rate (a measurement of kidney function). 

Participants in the RAMP-DM group were referred to specialists for any risk factors found. This group was also stratified into different risk levels based on risk factors and their A1C (a 90-day average of blood sugar levels). Participants with A1C levels of 7% or higher who were considered higher risk received more intense interventions and more frequent follow-ups with their medical team.    

To increase the validity of the study, when evaluating the data researchers excluded anyone who had a dementia diagnosis due to alcohol, drugs or infectious agents. Typical baseline data was also gathered, such as age, sex, BMI, cholesterol and triglyceride levels, blood pressure, fasting glucose levels and medications. Participants with missing baseline data were also excluded. 

After several statistical analyses were run on the data, researchers determined that while the RAMP-DM group had a slightly higher risk of dementia compared to people without diabetes, compared with the usual care group, patients in the RAMP-DM group had a 28% lower risk of incidence of all-cause dementia, 15% lower risk of Alzheimer’s disease, 39% lower risk of vascular dementia and 29% lower risk of other or unspecified dementia.

Further statistical analysis suggested that A1C levels equal to or above 7.5% were associated with increased risk for dementia. 

Interestingly, there was also a connection between A1C levels below 6.5% and dementia. Researchers explain that for the study, the “healthy” target A1C range was 6.5% to 7.5%. Levels below 6.5% suggested frequent incidences of hypoglycemia (low blood sugar) and poor glycemic control. 

This would suggest that poor glycemic control (aka management of blood sugar levels) may contribute to dementia risk.

How Does This Apply to Real Life?

The primary goal for people with diabetes is to maintain stable blood sugar levels. This can be easier said than done, but definitely achievable. It’s important to try to keep your blood sugar stable because, over time, inconsistent blood sugar levels (think: big spikes and crashes) can cause damage to body tissues, increasing your risk for a number of conditions, including heart disease, dementia, blindness and loss of limbs. 

In this study, the RAMP-DM group lowered their risk of dementia, in part, because they had more tools at their disposal to help manage their blood sugars than the control group did. You can use these same tools. 

If your primary health care provider is not referring you to other specialists, such as a registered dietitian and a certified diabetes educator, ask for the referrals. It’s also good to have a cardiologist and an ophthalmologist on your medical team for heart and eye health. And if you’re not satisfied with the care your primary health care provider is giving, ask for a referral to an endocrinologist, since they specialize in diabetes care.

If you’ve been prescribed medication, take it as prescribed. Check your blood sugar levels as frequently as your medical team has suggested and start noticing how you’re feeling in relation to your numbers. This can help you start connecting the dots between how you’re feeling with high and low blood sugars.

Diet is super important to pay attention to with diabetes. There are many myths surrounding food and diabetes—especially around carbohydrates—so be sure to get factual information by working with a registered dietitian and a certified diabetes educator. 

Other lifestyle factors that influence blood sugar levels are exercise, stress and sleep. Even being dehydrated can increase your blood sugar. 

While this may sound overwhelming, it doesn’t have to be if you take it one step at a time—literally. There is evidence that walking for just two minutes after meals can help lower blood sugar. 

The Bottom Line

Managing blood sugar is one piece of the puzzle—an important one—when it comes to protecting your brain and reducing your risk of dementia. If you feel you are showing signs of cognitive decline—especially if others are noticing mental glitches in you—speak with your health care provider about it. 

You may need to be an advocate for yourself regarding your diabetes care. Think of yourself as the CEO of your body, and put together a team of professionals who can help you meet your goal of safely managing your blood sugar levels. Remember that an occasional off reading isn’t what will affect your A1C level. It’s the frequent highs and lows that show up in your A1C, so consistent management of your blood sugars is what you’re going for. 

As with any other lifestyle habit change, managing diabetes can be broken down into the behaviors that affect it. Start where you’re at and gradually make changes in those areas. And lean on the advice and support of your diabetes care team.