Prevention and management of cognitive impairment in people with type 2 diabetes: An evidence-based guide for primary care

Type 2 diabetes is an established risk factor for cognitive impairment, cognitive decline and dementia. The clinical presentation of cognitive impairment in type 2 diabetes is broad and includes dementia, mild cognitive impairment and more subtle cognitive deficits that may be specific to type 2 diabetes. Several risk factors have been identified for cognitive impairment and dementia in type 2 diabetes, including vascular risk factors, depression and inflammation. Other than cardiovascular disease prevention, however, there is inadequate evidence to guide the specific treatment of any risk factor in preventing or slowing down cognitive decline. In parallel, there is very good evidence that cognitive impairment in type 2 diabetes predicts adverse diabetes outcomes, including increased risk of hypoglycaemia, and this should be considered by primary care practitioners when managing individuals with comorbid type 2 diabetes and cognitive impairment. Future interventional studies aiming to reduce cognitive decline in type 2 diabetes - in particular those addressing novel risk factors - in primary care are awaited.