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Abstract of the lecture by Professor Dr. rer. nat. Karin Lange at the press conference "Psychosocial and Diabetes" of the German Diabetes Society (DDG) on June 18, 2013 in Berlin.

When two diseases of old age come together

How can the large number of those affected be adequately cared for in the future?

Professor Dr. rer. nat. Karin Lange names the most important causes for the rise in dementia and other cognitive disorders. In addition to demographic change, type 2 diabetes and metabolic imbalances are among the most important risk factors. In addition, Professor Lange gives recommendations for care.

  1. The prognoses for the old-age quotient [1], ie the relation of the number of citizens over 65 years of age in relation to the number of citizens between 20 and 65 years of age, as well as data on the prevalence of dementias in Germany [2] show a for years challenging social task: A declining number of people in professional life is offset by a growing number of elderly and elderly people who are more and more often affected by irreversible cognitive decline processes with increasing age.

  2. Research data from the last decade indicate the importance of a secondary disease of diabetes that has so far been neglected: mild cognitive impairment (MCI) and dementia [3]. According to this, type 2 diabetes is associated with a 2 to 4-fold increased risk of vascular dementia and a 1.5 to 2-fold increased risk of Alzheimer's dementia.

  3. While long-term hyperglycemic metabolic conditions (too high blood sugar levels) increase the risk of cognitive impairment in the long term, severe hypoglycemia (low blood sugar levels) pose a particular risk for older and already cognitively impaired people with diabetes. [4]

The following recommendations are made for the treatment and care of people with diabetes and dementia

  • If there are signs of symptoms of cognitive impairment, the ability to responsibly self-treat diabetes should be checked in a structured manner and dementia screening carried out.

  • In the case of elderly people with diabetes, the heterogeneity of physical and psychological performance and the associated risks of this patient group should be taken into account when choosing the therapy goals and principles.

  • In older people with marked cognitive and / or functional limitations, HbA1c values ​​should be aimed for, in which hypoglycaemia can be safely avoided. However, hyperglycaemia that aggravates the geriatric syndromes or leads to dehydration should also be avoided, i.e. HbA1c values ​​of around 8 percent (64 mmol / mol) should be aimed for. Simple therapy concepts and nutritional recommendations adapted to daily routines should protect against excessive demands and maintain the quality of life.

  • In dementia patients, HbA1c values ​​are secondary, but quality of life impairing syndromes and hypoglycaemia should be avoided. Simple antihyperglycemic therapies, which are carried out by nurses with little stress on the patient, make more sense here than concepts that are overwhelming for both sides.

  • The complexity of the situation of many elderly patients with diabetes and simultaneous dementia makes a balanced cooperation between all professional healthcare providers and the family members / carers involved in the care necessary. In particular, further qualification offers for carers (relatives and professionals) are necessary here.

(The spoken word is valid!)


  1. Eisenmenger M, Pötzsch O, Sommer B. Federal Statistical Office (ed.) (2006) Report "Population of Germany until 2050. 11th coordinated population projection. Federal Statistical Office, Wiesbaden press office

  2. Weyerer S (2005) senile dementia. Federal health reporting [issue 28]. Berlin, Robert Koch Institute

  3. Strachan MW. (2011) The brain as a target organ in Type 2 diabetes: exploring the links with cognitive impairment and dementia. Diabetic Medicine, 28, 141-147

  4. Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP & Selby JV (2009) Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA, 301, 1565-1572

S2 guideline on psychosocial issues and diabetes - long version 2013
- Part 1 in: Diabetologie 2013, Edition 3,
- Part 2 in Diabetology 2013; Issue 4 (ET: August), 10.1055 / s-0033-1335889
- On the Internet:

Caption: Professor Dr. rer. nat. Karin Lange, 2nd chairwoman of the Diabetes and Psychology Working Group of the DDG; Head of the Research and Teaching Unit Medical Psychology; Hannover Medical School
Image source: German Diabetes Society (DDG)

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last modified: 06/18/2013