In the shadow of the global rise in noncommunicable diseases, a complex and mounting health crisis is unfolding across low- and middle-income countries (LMICs). It is not simply the surging rates of diabetes or the quiet march of dementia that are drawing the concern of public health experts—but the potent and often overlooked interplay between the two.
For over two decades, researchers have documented the connection between type 2 diabetes and cognitive decline. Today, that link is impossible to ignore. The latest figures from the International Diabetes Federation (IDF) Diabetes Atlas show that people with type 2 diabetes are 56% more likely to develop dementia than those without. A closer examination of the data reveals that diabetes is associated with a 103% increased risk of vascular dementia and a 34% increased risk of Alzheimer’s disease.
The connection is driven by shared biological pathways—chronic inflammation, insulin resistance in the brain, vascular damage and stroke risk—all of which are risks linked to diabetes. These risks amplify when the condition is diagnosed early. Every year that type 2 diabetes develops before the age of 65 increases dementia risk by 1.9%, underscoring the long tail of impact that begins decades before symptoms surface. As a result, the cognitive toll of diabetes is poised to worsen dramatically, especially in LMICs where both diabetes prevalence and ageing populations are increasing.
Every year that type 2 diabetes develops before the age of 65 increases dementia risk by 1.9%, underscoring the long tail of impact that begins decades before symptoms surface
According to the International Diabetes Federation, an estimated 57.4 million people globally are living with dementia, a figure projected to nearly triple to 152.8 million by 2050, mainly in LMICs, where rising life expectancy intersects with under-resourced health systems. Vascular dementia, which accounts for about 20% of all dementia cases, is particularly prevalent in these countries due to high rates of hypertension, obesity and stroke—conditions closely linked to type 2 diabetes.
Specialised dementia services are rare, and primary healthcare workers—often the first point of contact—frequently lack the training to diagnose or manage cognitive disorders. Without adequate support, the signs of dementia may be misread, dismissed or attributed to old age or even spiritual causes. Regarding the latter, in different regions of the world, dementia is often misconstrued as spiritual possession or witchcraft due to poor knowledge about the condition.
Specialised dementia services are rare, and primary healthcare workers—often the first point of contact—frequently lack the training to diagnose or manage cognitive disorders
While national spending on dementia care in LMICs hovers at just 0.45% of GDP, that figure conceals the cost borne by families. The financial strain can become overwhelming when families are left without structured support. Sometimes children are pulled out of school, or adults give up their jobs to care for a relative full-time. Caregivers, often women, provide unpaid and constant support. Indirect costs—including lost wages, reduced productivity and psychological strain—comprise nearly 60% of the total burden.
In practical terms, the annual cost of caring for someone with mild dementia is estimated at around €560 ($600 USD). For those with severe dementia, this can soar to more than €23,000 ($25,000) USD per year—an untenable sum for most households in low-resource settings.
The financial strain can become overwhelming when families are left without structured support. Caregivers, often women, provide unpaid and constant support
Yet, despite the growing data, many countries still have no national plan in place to confront the challenges of dementia. As of 2021, just one in four countries worldwide had adopted any form of national dementia policy, and only a handful of those were in LMICs. This gap leaves millions navigating a silent epidemic without the necessary policies, services or protections.
Yet the tools for change are within reach. The World Health Organization’s Global Action Plan on the Public Health Response to Dementia 2017–2025 outlines a clear roadmap: make dementia a public health priority, improve risk reduction, ensure early diagnosis and support carers.
Several promising initiatives are emerging. The STRiDE project (Strengthening Responses to Dementia in Developing Countries) is working to embed dementia care into primary health systems, train frontline workers, deploy early screening and develop culturally relevant community-based support models.
As of 2021, just one in four countries worldwide had adopted any form of national dementia policy, and only a handful of those were in LMICs
Experts stress that siloed approaches to health need to move towards integrated care models. Core features of these models are preventing or delaying dementia in people with diabetes. This means combining metabolic management, like managing blood glucose and cardiovascular risk factors, with cognitive health strategies, such as early screening and lifestyle interventions.
Healthy nutrition, physical activity, blood pressure management and the elimination of tobacco are all preventive measures that can reduce the risks of diabetes and dementia. These measures improve health outcomes and are often more cost-effective than late-stage treatment, especially in resource-constrained settings.
Public awareness also plays a critical role. In Nigeria , community-driven campaigns are working to dismantle stigma and educate people about dementia as a medical condition, not a supernatural affliction or inevitable part of ageing. While in India, the Alzheimer’s and Related Disorders Society of India (ARDSI) has created dementia-friendly communities and training initiatives for schoolchildren, healthcare professionals and caregivers to recognise and support people with dementia. In Latin America, Chile, Argentina and members of the Latin American and Caribbean Consortium on Dementia (LAC-CD) are tackling dementia stigma through national plans, public education campaigns and storytelling initiatives that promote understanding of the condition as a medical issue.
Experts stress that siloed approaches to health need to move towards integrated care models…preventing or delaying dementia in people with diabetes
The data is clear. The burden of dementia, especially when compounded by diabetes, will continue to escalate without targeted action. By 2050, a large portion of the global dementia burden will be in regions least equipped to cope.
But the crisis is not inevitable. Political will, primary care investment and policies linking metabolic and brain health can bend this trajectory. Integrated prevention, early detection and community-level support are not just aspirational goals—they are practical, proven solutions waiting to be scaled.
Millions are already living at the intersection of diabetes and dementia. The choice now is whether they face that future unsupported or with the systems, care and dignity they deserve.
What do type 2 diabetes and dementia have in common? In this podcast, host Phyllisa Deroze speaks with Professor Kaarin Anstey, a leading expert in ageing and brain health, to unpack the growing evidence linking the two conditions. Drawing on insights from the 11th Edition of the IDF Diabetes Atlas, they explore how the age of diabetes onset, vascular risks, and long-term management can influence cognitive decline. With dementia cases rising fastest in low- and middle-income countries, this conversation shines a light on why early detection, lifestyle interventions, and integrated care must be part of the global health agenda.
