Cognitive Decline Linked to Glucose Peaks in Diabetes Patients
Diabetes patients who experience glucose peaks face a higher risk of dementia and cognitive impairment, a recent study showed.
Past research has shown that HbA1c is related to risk of dementia and cognitive decline. However, little is known about how glycemic variability or glucose excursions impact this relationship.
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In the Atherosclerosis Risk in Communities (ARIC) study, nearly 13,000 participants were assessed for dementia and cognitive decline. The researchers measured dementia via surveillance, neuropsychological testing, telephone calls with participants or their proxies, or death certificate dementia codes. They also determined cognitive function z scores using 3 neuropsychological tests at 3 visits over 20 years.
1,5 Anhydroglucitol (1,5-AG) level was dichotomized at 10 μg/mL and examined within clinical categories of HbA1c.
Over a median period of 21 years, a total of 1105 developed dementia. In participants with diabetes, each 5 μg/mL decrease in 1,5-AG was associated with an increase in estimated dementia risk of 16%.
Among participants with diabetes and HbA1c levels lower than 7%, those with glucose peaks saw a decrease in z scores for cognitive decline by 0.19 over 20 years, compared with participants without glucose peaks. Additionally, among participants with diabetes and HbA1c levels of 7% or higher, those with glucose peaks saw a decrease in z scores by 0.38, compared with participants without glucose peaks.
However, there were no significant associations between glucose peaks and dementia or cognitive decline among participants without diabetes, the researchers noted.
“Among participants with diabetes, glucose peaks are a risk factor for cognitive decline and dementia,” the researchers concluded. “Targeting glucose peaks, in addition to average glycemia, may be an important avenue for prevention.”
—Christina Vogt
Reference:
Rawlings AM, Sharrett AR, Mosley TH, Ballew SH, Deal JA, Selvin E. Glucose peaks and the risk of dementia and 20-year cognitive decline. Diabetes Care. 2017;40(7):879-886. doi:10.2337/dc16-2203.