Microvascular complications caused by type 2 diabetes (T2D) contribute to cognitive impairment and depression, according to the results of studies published in Diabetes and Metabolic Syndrome. Investigators found that nephropathy in particular is strongly associated with cognitive decline.
The associations and strengths of these links vary depending on the type of complication, including diabetic nephropathy, neuropathy, and retinopathy. | Image credit: neirfy -stock.adobe.com
“Our systematic review and meta-analysis assessed microvascular complications in individuals with T2DM. [type 2 diabetes] The strength of these associations was found to be associated with a high prevalence of cognitive impairment and depression, although the strength of these associations was varied by type of complications,” the authors said.
T2D is associated with a variety of complications, and is associated with cardiovascular disease and other metabolic disorders. Furthermore, T2D has many effects on mental health outcomes. According to the CDC, diabetic patients are two to three times more likely to develop depression than patients without diabetes, while 25% to 50% of patients with diabetes and depression have a lower diagnosis and treatment rate. Furthermore, patients with diabetes are 20% more likely to suffer from anxiety than patients who do not.
Diabetes has also been identified as a major risk factor for cognitive dysfunction. A review published in the World Journal of Diabetes reveals that diabetes is largely self-controlled, so cognitive decline can be further exacerbated as a result of the effects of diabetes on local excess and mental capacity, such as local and hypoglycemia episodes of brain regions and hypoglycemia from insulin resistance and neuromatous episodes that cause insulin resistance and neuromatous damage.
In a systematic review and meta-analysis, the researchers aimed to determine the effects of diabetic neuropathy, retinopathy, and nephropathy on both cognitive impairment and depression. They included observational studies that included prevalence and association of cognitive impairment and depression in patients with diabetic complications. 5640 studies were identified and 4713 were screened. The investigators included a total of 7 after excluding the rest as it was an editorial or opinion, not an outcome of interest, and not a full-text article. There were six cross-sectional studies and one cohort study, two studies from China, two from Poland, one from Brazil, one from Greece and one from Japan.
The average age of the population was 56.8-73.6 years, with 26.3% to 64.6% being male. Microvascular complications included diabetic neuropathy, retinopathy, and nephropathy, alone or in combination. Investigators noted that 186 patients had a prevalence of 34.9% for neurological disorders, with a prevalence of 179 cases of 55.29% for retinopathy, and a prevalence of 40.97% for 51 cases of nephropathy. Researchers found that diabetic neuropathy and retinopathy were not statistically significant associations with the risk of cognitive impairment, but nephropathy did. Regarding the prevalence and risk of depression, neuropathy had a pool of 43.40%, retinopathy prevalence was 40.17%, and nephropathy prevalence was 18.92%. Retinopathy and nephropathy had a non-significant association between depression and microvascular diabetic complications. According to the study authors, there were critical and highly diverse associations between neurological disorders.
“The existence of substantial heterogeneity across research highlights the need for standardized methodologies in future research,” the authors concluded. “These findings support the implementation of routine mental health screening, early psychological interventions, and integration of mental health services into comprehensive diabetes management to improve patient outcomes and quality of life.”
Read more: Diabetes Resource Center
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Reference 1. Satapathy P, Pratima P, Gaidhane AM, et al. Prevalence and impact of microvascular complications in type 2 diabetes on cognitive impairment and depression: a systematic review and meta-analysis. Diabetol metabolism syndrome. 2025; 17(1): 187. Released June 3, 2025. doi: 10.1186/s13098-025-01759-92. CDC. Diabetes and mental health. May 15, 2024. Accessed June 4th, 2025. https://www.cdc.gov/diabetes/living-with/mental-health.html3. Sebastian MJ, Khan SK, Pappachan JM, Jeeyavudeen MS. Diabetes and cognitive function: An evidence-based current perspective. World J Diabetes. 2023; 14(2): 92-109. doi: 10.4239/wjd.v14.i2.92
