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Advice for people with diabetes and their families

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DUKPC research highlights: Days 7 & 8

Scientists have been busy sharing more of their latest findings during our professional conference (DUKPC). Over the last couple of days, research we funded has given us new insights that could help prevent dementia in people with type 2 diabetes. We've also learnt more about delays in the diagnosis of type 2 diabetes and the psychological impact of hypos.

New clues on the link between type 2 diabetes and dementia

We know that having type 2 diabetes can increase a person’s risk of developing dementia, but it’s not yet clear why. At DUKPC Dr Eszter Vamos, of Imperial College London, presented new findings that could help explain why the two conditions are linked.

With our funding, Dr Vamos looked to see if the factors affecting heart health in people with type 2 diabetes could also influence their dementia risk. High blood sugar levels, blood pressure and cholesterol in people with type 2 diabetes can damage blood vessels and lead to serious cardiovascular problems, such as heart attacks and strokes. It has been suggested that these ‘cardiometabolic factors’ might also affect brain health and could potentially play a role in the development of dementia in people with type 2 diabetes.

Dr Vamos analysed data from 227,580 people with type 2 diabetes and found around 10% went on to develop dementia over a 20-year period. The team examined the participants’ medical history across the 20 years before their dementia diagnosis to look at changes in cardiometabolic factors and body weight, and compared these to people who didn’t develop dementia.

Over the 20-year period, changes in blood pressure differed between those who did and didn’t develop dementia. People who developed dementia had higher blood pressure between 11 and 19 years before their dementia diagnosis, which then declined more steeply closer to their diagnosis, compared to those who didn’t develop dementia. A decline in body weight starting at 11 years before a dementia diagnosis was found in people who developed the condition, and this decline was steeper than in those who didn’t develop it.

Blood sugar and cholesterol levels were also found to be generally higher across the entire 20-year period among people with type 2 diabetes who developed dementia, compared to those who didn’t.

Dr Vamos explained that the results emphasise the importance of supporting people with type 2 diabetes to manage their blood pressure, cholesterol and glucose levels as soon as they are diagnosed, to help lower their risk of developing dementia later in life.

Dr Elizabeth Robertson, our Director of Research, said:

“These crucial findings have uncovered how type 2 diabetes may contribute to dementia onset. Changes in the body that lead to dementia occur years before symptoms arise, and for the first time, researchers have uncovered a pattern of changes in people with type 2 diabetes that are associated with dementia.

“Knowing which factors contribute to the development of dementia, and when they have the biggest impact, is vital in giving people with type 2 diabetes the best possible care to prevent or delay dementia onset.”

Next, with our funding, the researchers will investigate whether diabetes-related complications such as eye and kidney problems could be linked to dementia risk. The team will also examine whether risk factors for type 2 diabetes that we can’t control – such as age and ethnicity – could work alongside cardiometabolic factors to determine dementia risk.

People with type 2 diabetes wait over 2 years until diagnosis

Getting a prompt type 2 diabetes diagnosis is vital to make sure people get the treatment and support they need to manage the condition and reduce their risk of complications. But because the symptoms of type 2 diabetes can come on slowly, they can be easy to miss.

Dr Katie Young presented findings that revealed, on average, people living with undiagnosed type 2 diabetes are waiting more than two years before receiving a diagnosis from their GP.

The team of researchers at the University of Exeter looked at blood sugar levels from 200,000 participants of the UK Biobank who hadn’t been diagnosed with type 2 diabetes. They found that 1% had an HbA1c of 48mmol/mol (6.5%) or over. This is the threshold at which – when combined with other factors – type 2 diabetes is diagnosed.

By linking with the individuals’ GP records, they discovered it took an average of 2.3 years to get a diagnosis of type 2 diabetes from a healthcare professional. Almost a quarter of people (23%) still hadn’t received a diagnosis after five years of having elevated blood sugar levels.

Next, the team looked at factors linked with a bigger delay and found that women were likely to wait longer for a diagnosis. They also found that having a lower HbA1c (within the type 2 diabetes range) or a lower BMI, was associated with a delayed diagnosis. The researchers suggest that this was because these people may be less likely to experience symptoms or to be given a test to confirm type 2 diabetes.

This study highlights the importance of attending annual health checks if you’re over 40 years so that any elevated blood sugar levels can be detected early on.

12.3 million people in the UK are at an increased risk of developing the condition, but many will be unaware of their risk. If you’re concerned about type 2 diabetes, you can use our free online Know Your Risk tool. It could be the vital first step towards getting a diagnosis and getting the right care to stay healthy.

Hypos and mental wellbeing

Not being able to recognise the warning signs of hypos can be dangerous and have serious physical consequences, that include losing consciousness or going into a coma. But new research led by Professor Stephanie Amiel tells us more about the toll hypo unawareness takes on the psychological wellbeing of people with diabetes.

The researchers asked 97 people with type 1 diabetes to answer questions on their experiences of hypos and feelings towards them, and their psychological wellbeing. They found that people with hypo unawareness and who had frequent, severe hypos reported high levels of worry related to hypos, along with higher rates of anxiety and depression in general. This suggests that fear of hypos can have a negative impact on someone’s mental health.

The findings highlight how important it is that care for people with type 1 diabetes addresses both the physical and emotional aspects of managing the condition.

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