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The NDSS is administered by Diabetes Australia
The NDSS is administered by Diabetes Australia
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A photograph of an older man with glasses and a light blue shirt gesturing with his hand as he speaks to a female healthcare professional, whose back is to the camera, in a clinic setting

When diabetes self-management starts to change: recognising early signs of cognitive decline

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As Australia’s population ages, health professionals are increasingly caring for people living with both diabetes and cognitive decline.

Cognitive decline does not always begin with obvious memory problems. Early signs may first appear in how a person manages their diabetes1. This isn’t surprising, as diabetes self-management relies on memory, planning, problem-solving, and decision-making.

People with diabetes have an increased risk of cognitive decline and dementia, with chronic hyperglycaemia, hypoglycaemia, insulin resistance and vascular disease all thought to play a role234. Australian Census data from 2021 showed that dementia was around 15% more common in adults aged 60 to 99 years with diabetes than in those without diabetes5.

Signs to look out for

Slight changes in diabetes self-management can sometimes indicate a decline in cognitive function. Things to look out for include:

  • Missed medications or appointments
  • Difficulty remembering glucose checks
  • Trouble using glucose monitoring equipment
  • Errors when calculating insulin doses
  • New challenges with carbohydrate counting
  • Changes in eating habits such as forgetting meals or eating more often than usual
  • Difficulty recognising, communicating, or managing hypo symptoms
  • Increasing reliance on family members or friends for routine diabetes tasks

These changes may reflect difficulties with memory, planning, or problem-solving. The American Diabetes Association (ADA) recommends regular assessment of functional and self-management abilities in older adults living with diabetes6.

Practical ways to support people with diabetes and cognitive decline

Cognitive decline affects people differently. The impact on diabetes self-management can vary widely from person to person. These practical strategies can help health professionals recognise when additional support may be needed and adapt diabetes management to align with the person’s abilities, goals and support available78.

Ask about day-to-day diabetes management

A person’s self-management abilities can change before cognitive decline becomes obvious. In addition to reviewing glucose results, ask practical questions about day-to-day diabetes care, such as:

  • How are medications or insulin injections going?
  • Has treating hypos become more difficult?
  • Have there been any changes to eating habits or routines?

These conversations can help identify emerging difficulties early. If cognitive decline is suspected, refer the person to their GP or other appropriate specialist service for further assessment.

Prioritise safety

As cognitive function changes, preventing hypoglycaemia often becomes more important than achieving strict glycaemic targets.
Look for potential causes of hypoglycaemia, such as:

  • Missed meals
  • Incorrect insulin doses
  • Difficulties following instructions for medicines
  • Problems recognising or responding to hypo symptoms

Reducing the risk of hypoglycaemia can help maintain safety and quality of life.

Keep diabetes management as simple as possible

Consider whether the person’s treatment plan matches their abilities and available support. Simple changes can help make treatment more manageable, such as:

  • Clear written instructions
  • Simple hypo and sick-day action plans
  • Fewer calculations and complex decision-making where possible

Involve support people early

Family members, carers and support workers often notice changes before health professionals do. Early involvement can:

  • Identify concerns sooner
  • Reduce the burden of self-management
  • Improve treatment adherence
  • Support independence for longer

Many people can continue to manage diabetes successfully when appropriate support is in place.

Review whether diabetes technology is helping

Technology can reduce the burden of diabetes management, but only if it remains practical and manageable. Consider whether the person can:

  • Respond to continuous glucose monitoring alerts
  • Interpret glucose trends
  • Safely manage their insulin pump or connected devices

Start with what matters to them

Treatment decisions should be guided by the person’s goals, priorities and preferences, as well as their glucose targets.
Questions that may be helpful to ask include:

  • What health goals are most important to you?
  • What diabetes tasks worry you most?
  • What would help make diabetes easier to manage?

Taking a person-centred approach supports shared decision-making and help reduce the burden of diabetes self-management.

Key takeaway

Changes in diabetes self-management may be an early indicator of cognitive decline. Difficulties with routine diabetes tasks can appear before a formal diagnosis is made. Regularly assessing self-management abilities, simplifying treatment where appropriate, involving support people early and focusing on what matters most to the individual can help maintain safety, independence, and quality of life.

Resources and further information

References

  1. Hopkins R, Shaver K, Weinstock RS. Management of Adults with diabetes and cognitive problems. Diabetes Spect. 2016; 29 (4): 224-237. [cited 2026 Sep 8] Available from: https://diabetesjournals.org/spectrum/article/29/4/224/32739/Management-of-Adults-With-Diabetes-and-Cognitive. ↩︎
  2. Huang L, Zhu M, Ji J, A. Association between hypoglycemia and dementia in patients with diabetes: as systematic review and meta-analysis of 1.4 million patients. Diabetol Metab Syndr. 2022;14(1):31. Available from: https://link.springer.com/article/10.1186/s13098-024-01346-4 ↩︎
  3. Xu X, Li J, Pan H, et al. Insulin resistance and the risk of dementia: a systematic review and meta-analysis of prospective cohort studies. Available from: https://link.springer.com/article/10.1186/s12883-026-05079-x ↩︎
  4. Centres for Disease Control and Prevention. Your Brain and Diabetes. [Internet]. Atlanta (GA): CDC; 2024 [cited 2026 Sep 10]. Available from: https://www.cdc.gov/diabetes/diabetes-complications/effects-of-diabetes-brain.html ↩︎
  5. Mehta K, Gong JY, Santoso JA, Salim A, Stephan BCM, Anstey KJ, et al. Comparing dementia prevalence in Australians with and without diabetes across sociodemographic groups: Findings from the 2021 national census. J Alzheimers Dis. 2026; 111(3): 1385-1395. [cited 2026 Sep 8] Available from: https://pubmed.ncbi.nlm.nih.gov/41995583/ ↩︎
  6. American Diabetes Association Professional Practice Committee. 13. Older Adults: Standards of Care in Diabetes 2026. Diabetes Care. 2026;49 (Suppl 1): S277-S296. [cited 2026 Sep 8] Available from: https://diabetesjournals.org/care/article/49/Supplement_1/S277/163921/13-Older-Adults-Standards-of-Care-in-Diabetes-2026 ↩︎
  7. Hawkins AM, McCoy RG. Strategies for person-centred comprehensive diabetes management in older adults with cognitive impairment. Diabetes Obes Cardiometab CARE. 2026; 1(1): 153-163. [cited 2026 Sep 8] Available from: https://diabetesjournals.org/docm-care/article/1/1/153/164290/Strategies-for-Person-Centered-Comprehensive ↩︎
  8. Stuckey Hl, Vallis M, Kovacs burns K, Mullan-Jensen C, Reading JM, Kalra S, et al. Patient-centered care in diabetes care: concepts, relationships and practice. Diabetol Int. 2024; 15(3): 213-228 [cited 2026 Sep 8]. Available from Patient-centered care in diabetes care-concepts, relationships and practice – PMC ↩︎