A large US EHR-based cohort (All of Us) followed 283,772 adults ≥50 years (including 5,442 with type 1 diabetes) and found dementia risk was highest with type 1 diabetes vs no diabetes (adjusted HR 2.82; 95% CI 2.28–3.48) over a mean 2.4 years. The findings were published in Neurology.

Why It Matters To Your Practice

• Patients with type 1 diabetes appear to have a substantially higher relative risk of incident dementia than peers without diabetes, reinforcing the need to treat cognitive health as part of chronic disease management.

• The association held across sex, race, and ethnicity in this cohort, supporting broadly applicable counseling and screening vigilance.

Clinical Benefits

• Use the diagnosis of diabetes—especially type 1 diabetes—as a cue to incorporate brief cognitive symptom checks (e.g., memory, executive function concerns) into routine visits for older adults.

• Strengthen shared decision-making around glycemic targets and treatment complexity as patients age, balancing benefits with safety and self-management capacity.

Managing Risks

• Assess for contributors that can mimic or worsen cognitive symptoms (hypoglycemia episodes, sleep issues, depression, medication burden) and address modifiable factors.

• Recognize limitations: diabetes and dementia were identified via survey + EHR (ICD/SNOMED), so misclassification and under-capture are possible; follow-up was relatively short (mean 2.4 years).

The Bottom Line

• In this All of Us analysis, both type 1 and type 2 diabetes were linked to higher dementia risk vs no diabetes, with the highest risk in type 1 diabetes (aHR 2.82).

• For NPs and PAs, this supports proactive cognitive monitoring and care plans that account for aging, safety, and long-term brain health in patients with diabetes.