Neuropsychological Outcomes in Individuals With Type 1 and Type 2 Diabetes

Abstract

ObjectiveTo determine the prevalence of neuropsychological outcomes in individuals with type 1 diabetes compared to individuals with type 2 diabetes or without diabetes, and to evaluate the association of diabetes status and microvascular/macrovascular complications with neuropsychological outcomes.Patients and MethodsWe used a nationally representative healthcare claims database of privately insured individuals (1/1/2001-12/31/2018) to identify individuals with type 1 diabetes. Propensity score matching was used as a quasi-randomization technique to match type 1 diabetes individuals to type 2 diabetes individuals and controls. Diabetes status, microvascular/macrovascular complications (retinopathy, neuropathy, nephropathy, stroke, myocardial infarction, peripheral vascular disease, amputations), and neuropsychological outcomes (mental health, cognitive, chronic pain, addiction, sleep disorders) were defined using ICD-9/10 codes. Logistic regression determined associations between diabetes status, microvascular/macrovascular complications, and neuropsychological outcomes.ResultsWe identified 184,765 type 1 diabetes individuals matched to 524,602 type 2 diabetes individuals and 522,768 controls. With the exception of cognitive disorders, type 2 diabetes individuals had the highest prevalence of neuropsychological outcomes, followed by type 1 diabetes, and controls. After adjusting for the presence of microvascular/macrovascular complications, type 1 diabetes was not significantly associated with a higher risk of neuropsychological outcomes; however, type 2 diabetes remained associated with mental health, cognitive, and sleep disorders. The presence of microvascular/macrovascular complications was independently associated with each neuropsychological outcome regardless of diabetes status.ConclusionMicrovascular/macrovascular complications are associated with a high risk of neuropsychological outcomes regardless of diabetes status. Therefore, preventing microvascular and macrovascular complications will likely help reduce the likelihood of neuropsychological outcomes either as the result of similar pathophysiologic processes or by preventing the direct and indirect consequences of these complications. For individuals with type 2 diabetes, risk factors beyond complications (such as obesity) likely contribute to neuropsychological outcomes.

Association between brain health outcomes and metabolic risk factors in persons with diabetes

“… 21 Furthermore, a single study found heart rate variability CAN outcomes, associated with cognition. 22 In contrast, we were surprised neuropathy did not associate with cognitive function, despite a previously documented relationship, 6 possibly from a lack of statistical power in the present study. The underlying mechanisms dictating the relationship between cognitive impairment, CAN, and CKD remains unknown.…”

“…We found that CAN and CKD measures associated with smaller gray matter volumes and increased WMH, consistent with our recent study based on a large cohort of individuals with and without T2d, which found that diabetes complications increased the odds of a cognitive disorder by 2.45 in those aged 40–60 years 6 . Our results are also consistent with a systematic review that found cognitive impairment was common in individuals with CKD, 20 although in a separate study of American Indians of the Zuni Pueblo, CKD measurements did not associate with cognition 21 .…”

“…4,5 Furthermore, our recent large, nationally representative study found diabetes complications associated with cognitive disorders. 6 Pima American Indians have a higher prevalence of T2d with an earlier onset than individuals with T2d in the general population. 7 Pima American Indians also have a higher prevalence of neuropathy, obesity, and hypercholesterolemia, as well as a higher incidence of chronic kidney disease (CKD).…”

“…This increase may be partly attributed to the increasing worldwide prevalence of type 2 diabetes (T2d) and obesity, 2,3 as meta‐analyses suggest diabetes and midlife obesity associate with cognitive impairment and dementia 4,5 . Furthermore, our recent large, nationally representative study found diabetes complications associated with cognitive disorders 6 …”

“… 4 , 5 Furthermore, our recent large, nationally representative study found diabetes complications associated with cognitive disorders. 6 …”