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REVIEW ARTICLE

Hypoglycemia as a risk factor for dementia in diabetes: A systematic review

Monish Konda1 ,  Charan Lingutla2 ,  Vinay Eruvuri3 ,  Shruthi Reddy Gatla4 ,  Yethindra Vityala5*
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1 Department of General Medicine, Shri B. M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India
2 Department of General Medicine, Gandhi Medical College and Hospital, Hyderabad, Telangana, India
3 Department of General Medicine, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India
4 Department of General Medicine, Ramdev Rao Hospital, Hyderabad, Telangana, India
5 Honorary International Faculty, AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India
Advanced Neurology, 025270077 https://doi.org/10.36922/AN025270077
Received: 30 June 2025 | Revised: 4 September 2025 | Accepted: 12 September 2025 | Published online: 9 October 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Diabetes is a global health concern associated with complications such as cognitive decline and dementia. This systematic review investigated the risk of hypoglycemia and dementia in patients with diabetes. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science for cohort studies published between January 1, 2020, and March 15, 2025. Eight studies with over 1.1 million individuals with diabetes, mainly type 2 diabetes (T2D), were included. The selected studies were conducted in various countries and had follow-up periods ranging from 5.9 to 9.14 years. This review demonstrated that hypoglycemic episodes are strongly associated with an increased risk of cognitive decline, including Alzheimer’s disease, vascular dementia, and all-cause dementia. The hazard ratios ranged from 1.25 to 2.80, with multiple episodes significantly increasing the likelihood of dementia. Blood sugar fluctuations, particularly increased hemoglobin A1c levels and variability, heighten the risk of dementia. Sex-based analyses showed that women with T2D faced a higher risk of dementia linked to glycemic factors. The relationship between hypoglycemia and cognitive decline is bidirectional, with cognitive decline affecting diabetes management and leading to hypoglycemia. The findings underscore the importance of maintaining stable blood sugar levels, setting treatment goals, and incorporating cognitive assessments in diabetes care for older adults.

Keywords
Diabetes
Hypoglycemia
Dementia
Alzheimer’s disease
Vascular dementia
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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