Dementia Burden and Modifiable Risk Factors in Type 2 Diabetes: Population Based, Prospective Cohort Study

To evaluate the global dementia burden attributable to type 2 diabetes (T2D) from 1990 to 2050 and assess the potential for dementia prevention in T2D through targeted risk factor modification.

This multinational study used data from the prospective UK Biobank cohort and the Global Burden of Disease Study 2021. Lifetime risk of dementia in T2D was quantified with cumulative incidence functions. The T2D-attributable dementia burden was assessed across 204 countries/territories from 1990 to 2050. Further, modifiable risk factors for dementia in T2D were evaluated using multivariable Cox models, and potential preventive effects were quantified.

T2D was associated with a higher risk and earlier onset of dementia, especially in cases with T2D diagnosed at ages 30-54 years. Globally, an estimated 9.57 million (95% CI, 5.59-10.39) dementia cases in 2021 were attributable to T2D, accounting for 16.85% (9.64%-18.33%) of the global dementia burden, and this proportion is expected to exceed 25% by 2050. This increasing risk of dementia in T2D was significantly associated with multidomain modifiable risk factors, and optimizing all these factors to favourable levels could potentially prevent 47.1% of dementia cases in T2D. To facilitate the clinical practice of risk prevention, a concise set of T2D Cognitive Health Essential 10 with evidence-based intervention targets was further developed, which was associated with no significant excess dementia risk in T2D.

T2D-attributable dementia is a time-evolving, escalating, and highly modifiable global health challenge. Integrating multidomain interventions into standard diabetes care, particularly for individuals with younger-onset T2D, and adapting strategies to local contexts may substantially reduce the dementia burden.