Abstract
Controversy exists in diabetes management after the onset of MCI, and the ideal treatment goals and medication use in this population remain inconclusive. This review aimed to comprehensively summarize the existing literature on diabetes management after MCI onset, focusing on the change of A1c goals, medication choices, and the risk of ADRD onset. We conducted a systematic literature search in PubMed (2000.1.1-2021.9.30) to identify studies related to mild cognitive impairment, glycemic goal, and medication use after MCI onset. Study types include guidelines, clinical trials, and observational studies. A standard literature searching process including title/abstracts screening, duplication removal, eligibility assessment, and data extraction was conducted by two reviewers independently. We have identified 30 studies addressing the management of diabetes in patients with MCI. The study contents were categorized into two main focuses; glycemic control (moderate vs. intensive) and the role of medications in delaying ADRD onset. Most guidelines recommend individualized goal setting to a relaxed glycemic target to avoid hypoglycemia after MCI onset. On the other hand, existing evidence linked improved glycemic control with a lower risk of ADRD onset. Observational studies and small-sized trials found the use of metformin, TZD, DPP4, and GLP-1 receptor agonists may be able to slow down the cognitive function decline. However, whether such effects were attributable to improved glycemic control or other mechanisms such as neutral protective effect is inconclusive. The risk-benefit tradeoff in glycemic control is vital in diabetes population with MCI. A large gap exists in understanding the underlying mechanism for the potential protective effect of cognitive function from glucose-lowering medications.