COMMENTARY

Alzheimer Risk in Diabetes: What to Tell Patients?

Anne L. Peters, MD, CDE

Disclosures

October 19, 2011

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Hi. I am Dr. Anne Peters, Director of the Clinical Diabetes Programs at the University of Southern California. I am here today to discuss 2 Alzheimer-related articles that my patients have read recently in the newspapers. The first is news that patients with diabetes are at double the risk of developing Alzheimer disease. This report was based on a study conducted in Japan[1] with 1000 individuals who were followed over time, and those with diabetes had close to twice the risk of developing Alzheimer disease compared with those who didn't have diabetes. This is obviously very disturbing to patients in part because, obviously, nobody wants to get Alzheimer disease but also because there isn't all that much we can tell them to do about it.

The study wasn't a treatment study; it was an observational study, so we are not able to show that improving diabetes control is going to make a difference in terms of the risk of developing Alzheimer disease. The risk for Alzheimer disease is likely multifactorial in these patients with diabetes. It may involve their increased risk for cardiovascular disease, increased glucose levels, the presence of insulin resistance, the finding of amyloid plaques in the brain as well as in the pancreas, or a genetic predisposition. This risk is actually present in individuals with prediabetes as well as those with diabetes. When I talk about this with patients, I say "yes, there may be an increased risk," but I also talk about the overall benefit of improving all the factors that we know how to improve -- lowering the risk for vascular disease, improving lipids, blood pressure and glucose control, and the role of lifestyle -- diet, exercise, and lowering the risk for all sorts of complications of diabetes. Although I can't take this one away from patients, at least I can discuss what I believe is helpful diabetes care and talk about the potential for research to uncover the link and hopefully, help reduce it in the future.

The second article[2] was about giving individuals with mild Alzheimer disease (but who do not have diabetes) inhaled insulin to lower their risk for progression to more severe disease. This isn't inhaled insulin similar to what we had in the past. This is a nasal inhaler, a very specific kind of inhaler, and it is not on the market, by the way, so your patients can't get it. It pushes the insulin, spraying it high in the nose, achieving higher insulin levels close to or into the brain. This appeared to help slow the progression of mild Alzheimer disease. Only 100 patients were studied, and these patients did not have diabetes. The dose of insulin used did not affect their peripheral blood glucose levels but did seem to have a positive benefit. This was, however, a very small study and I hope it is going to be validated in much larger studies to come. I discuss this with patients. I talk about how interesting it is as a theory but also that this isn't going to affect them in terms of insulin use by someone with diabetes, even if we have ways to give inhaled insulin in the future.

These are concerns that my patients have been discussing with me, so I thought it would be useful to talk about them. I would like to stress, again, the importance of both preventing diabetes and treating diabetes in a multifactorial way. These are very vulnerable individuals who can get all sorts of complications, and hopefully over time we will better figure out how to reduce that risk. This is Dr. Anne Peters for Medscape.

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