The Final Frontier: How Does Diabetes Affect the Brain?

  1. Elizabeth R. Seaquist, MD
  1. From the Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
  1. Corresponding author: Elizabeth R. Seaquist, seaqu001{at}umn.edu.

Our understanding of the impact of diabetes on organ function has been evolving since the discovery of insulin in the 1920s. At that time insulin was a miracle drug that appeared to cure diabetes, but over time it became clear that death and disability from diabetes complications involving the eyes, kidneys, peripheral nerves, heart, and vasculature could occur even with treatment. With the improvement in diabetes care over the past 20 years, fewer patients are developing the traditional diabetes complications. However, as people live long and well with the disease, it has become apparent that diabetes can alter function and structure in tissues not typically associated with complications such as the brain and bone. Alteration in brain structure and function are particularly of concern because of the impact of dementia and cognitive dysfunction on overall quality of life.

From large epidemiological studies, it has been demonstrated that both vascular and Alzheimer's dementia are more common in patients with type 2 diabetes (1). Why this might be true has been difficult to define. Certainly these patients can be expected to have more risk factors such as previous cardiovascular disease, history of hypertension, and dyslipidemia than aged matched control subjects, but when these variables are controlled, the risk for …

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