Diabetes Microvascular Complications Linked With Cognitive Impairment, Depression
The associations and strengths of these links varied by the complication type, including diabetic nephropathy, neuropathy, and retinopathy.
Microvascular complications due to type 2 diabetes (T2D) contribute to cognitive impairment and depression, according to results of a study published in Diabetology and Metabolic Syndrome. Investigators found that nephropathy in particular is strongly linked to cognitive decline.1
The associations and strengths of these links varied by the complication type, including diabetic nephropathy, neuropathy, and retinopathy. | Image Credit: neirfy - stock.adobe.com
“Our systematic review and meta-analysis assessed microvascular complications in individuals with T2DM [type 2 diabetes] were found to be linked with a high prevalence of cognitive impairment and depression, although the strength of these associations varied by complication type,” the study authors said. “Diabetic nephropathy demonstrated a statistically significant relationship with cognitive impairment, whereas associations for neuropathy and retinopathy with cognitive impairment or depression were generally weaker and not statistically significant.”
T2D is associated with various complications and is linked to cardiovascular disease and other metabolic disorders. Additionally, T2D has many impacts on mental health outcomes. According to the CDC, people with diabetes are 2 to 3 times more likely to have depression than patients without diabetes, and there is a low rate of diagnosis and treatment at only 25% to 50% for patients with diabetes and depression. Further, patients with diabetes are 20% more likely to have anxiety than those without.2
Diabetes has also been identified as a major risk factor for cognitive dysfunction. In a review published in World Journal of Diabetes, since diabetes is largely self-managed, cognitive decline can further worsen as a result of diabetes’ effects on neuronal function and mental capacity, such as local hyper- and hypometabolism of brain areas from insulin resistance and recurrent hypoglycemic episodes resulting in neuronal damage.3
In the systematic review and meta-analysis, investigators aimed to determine the impact of diabetic neuropathy, retinopathy, and nephropathy on both cognitive impairment and depression. They included observational studies that included the prevalence and association of cognitive impairment and depression for patients with diabetic complications. There were 5640 studies identified, with 4713 being screened. Investigators included a total of 7 after excluding the rest due to being editorials or opinions, not containing outcomes of interest, or not being full-text articles. There were 6 cross-sectional studies and 1 cohort study, with 2 studies from China, 2 from Poland, 1 from Brazil, 1 from Greece, and 1 from Japan.1
The populations had mean ages ranging from 56.8 to 73.6 years, with 26.3% to 64.6% being men. Microvascular complications included diabetic neuropathy, retinopathy, and nephropathy, either alone or as a combination. Investigators noted that 186 patients had a combined prevalence estimate of 34.9% for neuropathy, 179 had a prevalence of 55.29% for retinopathy, and 51 had a prevalence of 40.97% for nephropathy. Investigators found that diabetic neuropathy and retinopathy had no statistically significant association with the risk of cognitive impairment, but nephropathy did. As for the prevalence and risk of depression, neuropathy had a pooled prevalence of 43.40%, retinopathy had a prevalence of 40.17%, and nephropathy had a prevalence of 18.92%. Retinopathy and nephropathy had a nonsignificant association between depression and microvascular diabetic complications. Neuropathy had inconclusive and highly variable associations, according to the study authors.1
“The presence of substantial heterogeneity across studies underscores the need for standardized methodologies in future research,” the authors concluded. “These findings support the implementation of routine mental health screening, early psychological intervention, and integration of mental health services into comprehensive diabetes management to improve patient outcomes and quality of life.”
READ MORE: Diabetes Resource Center
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