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To the Editor: Dr Whitmer and colleagues¹ reported a relationship between severe hypoglycemia and incident dementia in a large cohort of older people with type 2 diabetes. Although severe hypoglycemia may cause permanent cognitive impairment, the results of this study should be viewed with caution. It seems unlikely that a single episode of severe neuroglycopenia could increase the risk of dementia by 50%.

Premorbid cognitive ability was assessed solely by educational attainment. Intellectually able people with diabetes may compensate for declining cognition and be less susceptible to the development of hypoglycemia. Vascular dementia is more common in people with lower cognitive ability² and may confound a putative association with hypoglycemia. Cerebrovascular disease may both cause dementia and enhance the risk of hypoglycemia. Although the results were adjusted for the most overt diagnoses of stroke, which have a prevalence in the general population of 2% to 3%,³ no adjustment was made . . . [Full Text of this Article]

Alex J. Graveling, MBChB, MRCP; Brian M. Frier, BSc, MD, FRCP
brian.frier@luht.scot.nhs.uk
Department of Diabetes
Royal Infirmary of Edinburgh
Edinburgh, United Kingdom

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