Effect of poor glycemic control in Cognitive Performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study

Abstract

BackgroundCognitive impairment is twice more frequent in elderly with type 2 diabetes mellitus (DM). This study was conducted to determine the association between glycemic control and cognitive performance among community-dwelling elderly persons in Mexico.MethodsCross-sectional study conducted in individuals aged 60 years or elderly participating in the 2012 Mexican Health and Aging Study. Type 2 DM participants were classified in 3 groups according to their glycated hemoglobin levels (HbA1c): <7% (intensive control), 7-7.9% (standard control) or ≥ 8% (poor control), and cognitive performance: low (CCCE ≤44 points), intermediate (44.1-59.52 points), or high (≥59.53 points). Multinomial logistic regression models were constructed to determine this association.Results216 community-dwelling adults aged 60 and older with type 2 diabetes were selected. Subjects in the low cognitive performance group were older (69.7 ± 6.6 vs 65.86 ± 5.18 years, p <.001) and had a lower educational level (2.5 ± 2.6 vs 7.44 ± 4.15 years, p <.000) when compared to the high cognitive performance participants. HbA1c ≥8% was associated with having low (Odds Ratio (OR) 3.17, 95% CI 1.17-8.60, p=.024), and intermediate (OR 3.23, 95% CI 1.27-8.20, p=.014) cognitive performance; this trend was not found for HbA1c 7.0-7.9% group.The multinomial regression analysis showed that the presence of HbA1c ≥8% (poor glycemic control) was associated with low (OR 3.17, 95% CI = 1.17-8.60, p=.024), and intermediate (OR 3.23, 95% CI = 1.27-8.20, p=.014) cognitive performance. After adjusting for confounding variables.ConclusionsGlycemic control with a HbA1c ≥ 8% was associated with worse cognitive performance.

Associations of the Glycaemic Control of Diabetes with Dementia and Physical Function in Rural-Dwelling Older Chinese Adults: A Population-Based Study

“…Similar to our results, the cross-sectional Mexican Health and Ageing Study of 216 older participants showed that poor glycaemic control was associated with worse global cognitive performance. 11 Furthermore, a longitudinal study including 1289 American participants from the Alzheimer's Disease Neuroimaging Initiative suggested that untreated diabetes was associated with a higher risk for dementia, whereas treated diabetes was not, implying that the risk of diabetes-related dementia may be attenuated by glycaemic control. 32 However, these studies had relatively smaller sample sizes, were of different ethnicities, did not make accurate dementia and dementia subtype diagnoses, or classified the participants with diabetes by self-reported antidiabetic agent status, without taking blood glucose levels into account.…”

“…Furthermore, the previously published studies were limited by small sample sizes, case-control designs, selection bias, or neuropsychological test performance but not accurate dementia diagnosis. 11,12 In addition to cognitive function, physical function is also an important aspect that affects the quality of life of older adults, acting as a strong predictor of mortality, hospitalization, and disability. 13 Several studies have shown that diabetes is associated with worse physical functioning among older adults.…”

Poor Glycemic Control is Correlated with Reduced Cognitive Function in Type 2 Diabetes Mellitus Patients

“…The group with poor glycemic control was found experiencing a significant decline in cognitive function. 17 Differences in significance compared to previous studies might be related to the cognitive function instruments and the classification criteria related to the blood glucose control group that was used in our study. However, when the correlation test was conducted between HbA1c levels and AD8 scores, a significant correlation between the two variables was found (p=0.031).…”

Connecting vascular aging and frailty in Alzheimer’s disease

“…Clinical data are available so far for insulin (Craft et al, 2012), metformin (Koenig et al, 2017), thiazolidinediones (Sato et al, 2011), and GLP-1 agonists (Gejl et al, 2017), and convincing evidence on sodium-glucose cotransporter 2 inhibitors (Hierro-Bujalance et al, 2020) and dipeptidyl-peptidase IV inhibitors (Kosaraju et al, 2017) are emerging from animal studies. A meta-analysis of 40 studies revealed a negative relationship between HbA1c levels and working memory/executive function (Mansur et al, 2018), and a similar association was reported for cognitive performance (Mimenza-Alvarado et al, 2020). On the other hand, RCTs assessing the impact of different degrees of glycemic control on cognitive function showed variable outcomes.…”