Report on the Interrelation of Diabetes and Dementia in the Context of Sustainable Development Goal 3

Introduction: Advancing SDG 3 Through Integrated Health Research

Recent scientific findings underscore a significant bidirectional relationship between diabetes and dementia, two prominent non-communicable diseases (NCDs). Understanding this link is critical to advancing Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. Specifically, this research directly supports Target 3.4, focused on reducing premature mortality from NCDs through prevention and treatment and promoting mental health.

Key Findings on the Diabetes-Dementia Nexus

An analysis of current evidence reveals ten critical points illustrating the connection between metabolic and cognitive health, highlighting areas for intervention to meet global health targets.

1. Elevated Dementia Risk in Diabetic Populations: Individuals with diabetes face a substantially higher risk—approximately 60%—of developing dementia. Frequent low blood sugar episodes are linked to a 50% increased chance of cognitive decline, emphasizing the need for integrated care strategies under SDG 3 to manage NCDs holistically.
2. Systemic Impact of Insulin Resistance: Insulin resistance, a primary driver of type 2 diabetes, also impairs brain cell function by hindering glucose utilization. This contributes to cognitive decline, linking metabolic dysfunction directly to neurological health, a key concern for well-being under SDG 3.
3. Cerebral Glucose Metabolism Impairment: In dementia, brain cells exhibit a reduced capacity to use glucose for energy. This condition, sometimes unofficially termed “type 3 diabetes,” signifies a critical metabolic failure that compromises brain health.
4. Reciprocal Risk: Alzheimer’s and Diabetes: The relationship is bidirectional. Alzheimer’s disease can precipitate pre-diabetic conditions by elevating fasting blood glucose levels. Furthermore, the primary genetic risk factor for Alzheimer’s, the APOE4 variant, is linked to reduced insulin sensitivity, reinforcing the need for comprehensive NCD management.
5. Vascular Damage as a Common Pathway: Diabetes-induced damage to blood vessels is a well-documented contributor to complications in multiple organs, including the brain. This vascular pathology, which includes reduced blood flow, inflammation, and a weakened blood-brain barrier, is strongly associated with dementia, presenting a common target for preventative health measures aligned with SDG 3.

Therapeutic Innovations and Their Contribution to SDG 3

Research into diabetes treatments has yielded unexpected benefits for neurological health, demonstrating the power of scientific innovation to address complex health challenges outlined in SDG 3.

• Repurposing of Memantine: Originally developed as a diabetes medication, Memantine is now used to treat Alzheimer’s symptoms, illustrating how cross-disciplinary research can lead to novel therapeutic applications.
• Neuroprotective Potential of Metformin: Metformin, a widely used diabetes drug, may offer neuroprotective benefits by reducing brain inflammation. Studies suggest its use is associated with a lower risk of dementia among diabetic patients.
• GLP-1 Receptor Agonists: Medications like semaglutide, used for weight loss and blood glucose control, are associated with a reduced dementia risk in diabetic individuals and are currently being trialed for early-stage Alzheimer’s.
• Intranasal Insulin Therapy: Direct delivery of insulin to the brain via nasal sprays is being explored as a method to counteract cerebral insulin resistance. Small studies suggest potential memory benefits, but further research is needed to establish efficacy and safety.
• SGLT2 Inhibitors: Emerging evidence suggests that SGLT2 inhibitors may be superior to other diabetes medications in reducing dementia risk, including Alzheimer’s and vascular dementia, by mitigating neuroinflammation.

Conclusion: A Unified Approach to Non-Communicable Diseases

The extensive evidence linking diabetes and dementia necessitates a unified public health strategy. Managing diabetes effectively is not only crucial for preventing cardiovascular and renal complications but also for preserving long-term brain health. The success in developing multiple classes of diabetes medications offers a promising avenue for mitigating dementia risk, thereby contributing significantly to the achievement of SDG 3. Future research should clarify whether these benefits extend to non-diabetic populations, potentially broadening the impact on global health and well-being.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: This is the primary SDG addressed in the article. The entire text focuses on the health implications of non-communicable diseases, specifically the link between diabetes and dementia (a condition affecting mental health and well-being). It explores the risks, biological mechanisms, and treatments associated with these conditions, directly aligning with the goal of ensuring healthy lives and promoting well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
  • The article directly relates to this target by discussing the prevention and treatment of dementia, a condition affecting mental health, through the management of diabetes, a non-communicable disease. It highlights how treatments for diabetes, such as Metformin, GLP-1 receptor agonists, and SGLT2 inhibitors, can reduce the risk of cognitive decline and dementia. This demonstrates a focus on treatment to mitigate the adverse effects of a non-communicable disease.
• Target 3.b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines…
  • The article extensively covers the research and development of medicines for non-communicable diseases. It mentions the history of Memantine (originally a diabetes drug repurposed for Alzheimer’s), ongoing trials for Metformin and semaglutide (Evoke and Evoke Plus trials), and new evidence for SGLT2 inhibitors. The text states that “diabetes research has been very successful in creating at least 13 different classes of drugs, multiple combination therapies, giving rise to at least 50 different medicines,” which underscores the commitment to R&D in this field.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.4: While the article does not provide mortality rates, it offers several indicators related to disease risk and treatment effectiveness that can be used to measure progress in prevention and treatment.
  • Risk Prevalence: The statement that “People with diabetes are about 60% more likely to develop dementia” serves as a baseline indicator of the health burden and the link between these non-communicable diseases.
  • Effectiveness of Treatment: The article implies progress by citing studies on various drugs. For example, it notes that people with diabetes taking Metformin are “less likely to develop dementia,” that GLP-1 drugs were “even more effective than metformin at reducing dementia risk,” and that SGLT2 inhibitors are “superior at reducing dementia risk.” These comparative effectiveness findings serve as qualitative indicators of improved treatment outcomes.
• For Target 3.b: The article provides indicators related to the output of research and development activities.
  • Volume of Available Medicines: The mention of “at least 13 different classes of drugs” and “at least 50 different medicines” for diabetes is a direct indicator of the successful development of treatments for a major non-communicable disease.
  • Ongoing Research Activities: The reference to specific clinical trials, such as “Evoke and Evoke Plus,” which are testing semaglutide for Alzheimer’s, is an indicator of continued investment and activity in the research and development of new medicines.

4. Table of SDGs, Targets, and Indicators

Source: sciencealert.com