Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes

Feinkohl, Insa; Keller, M; Robertson, Christine; Morling, Joanne R; McLachlan, Stela; Frier, Brian M.; Deary, Ian J.; Strachan, Mark W. J.; Price, Jackie F.

doi:10.1007/s00125-015-3581-0

Cited by 21 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with diabetes generally show greater cerebral and hippocampal atrophy [32-34], cerebral microvascular [35, 36] and macrovascular damage [37], and are also at increased risk of cognitive impairment [15, 38, 39] compared with non-diabetics. Similar observations have been made for hyperglycaemia short of diabetes diagnosis [40, 41] and poorer glycaemic control in patients with diabetes [42], which indicates fundamental influences of impaired glucose metabolism on the brain. It appears that the negative impact of hyperglycaemia on brain function may be accelerated due to surgery as it was observed for patients with diabetes during relatively short follow-up periods of 3–12 months in the present analysis.…”

Section: Discussionsupporting

confidence: 54%

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Lachmann

Feinkohl

Borchers

et al. 2018

Dement Geriatr Cogn Disord

Self Cite

View full text Add to dashboard Cite

Background/Aims: Older people undergoing surgery are at risk of developing postoperative cognitive dysfunction (POCD), but little is known of risk factors predisposing patients to POCD. Our objective was to estimate the risk of POCD associated with exposure to preoperative diabetes, hypertension, and obesity. Methods: Original data from 3 randomised controlled trials (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis on diabetes, hypertension, baseline blood pressure, obesity (BMI ≥30 kg/m²), and BMI as risk factors for POCD in multiple logistic regression models. Risk estimates were pooled across the 3 studies. Results: Analyses totalled 1,034 patients. POCD occurred in 5.2% of patients in DECS, in 9.4% in SuDoCo, and in 32.1% of patients in OCTOPUS. After adjustment for age, sex, surgery type, randomisation, obesity, and hypertension, diabetes was associated with a 1.84-fold increased risk of POCD (OR 1.84; 95% CI 1.14, 2.97; p = 0.01). Obesity, BMI, hypertension, and baseline blood pressure were each not associated with POCD in fully adjusted models (all p > 0.05). Conclusion: Diabetes, but not obesity or hypertension, is associated with increased POCD risk. Consideration of diabetes status may be helpful for risk assessment of surgical patients.

show abstract

Section: Discussionsupporting

confidence: 54%

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Lachmann

Feinkohl

Borchers

et al. 2018

Dement Geriatr Cogn Disord

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, total brain volume was increased in a group receiving targeted glycaemic control therapy, but in spite of this no differences were found in cognitive outcomes [7]. In general, it is difficult to determine the direction of causality in the association between type 2 diabetes and cognitive decline, but the current literature suggests that having type 2 diabetes causes greater cognitive decline [11, 12, 19, 45, 46]. …”

Section: Discussionmentioning

confidence: 99%

Cognitive function in early and later life is associated with blood glucose in older individuals: analysis of the Lothian Birth Cohort of 1936

Starr

Deary

2018

Diabetologia

Self Cite

View full text Add to dashboard Cite

Aims/hypothesisThe aim of this study was to examine whether cognitive function in early and later life, and decline in cognitive function from age 70 to 79 years, are associated with high blood glucose, as measured by HbA1c, at baseline (age 70), and changes in blood glucose from age 70 to 79.MethodsParticipants (n = 1091) in the Lothian Birth Cohort of 1936 were examined. Fourteen tests were used to assess cognitive functions, grouped into four domains: visuospatial ability, processing speed, memory and crystallised ability. Test results, and measurements of HbA1c and other health variables, were collected at each of four waves of assessment: at the mean age of 70, 73, 76 and 79 years. Data on cognitive function at age 11 was also available for this cohort. Latent growth curve modelling was performed and statistical controls for known risk factors were introduced.ResultsHigher age 11 cognitive function predicted lower HbA1c level at age 70 (p < 0.001). Higher cognitive function at age 70 was related to a comparatively smaller increase in HbA1c levels from age 70 to 79 (p < 0.001). HbA1c from age 70 to 79 did not have any consistent association with change in cognitive function from age 70 to 79. These associations survived adjustments for age, sex, education, APOE*ε4, smoking history, cardiovascular disease history, hypertension history, BMI and corrections for multiple testing.Conclusions/interpretationOur results show that, among older individuals, high blood glucose is consistently predicted by lower cognitive function. Clinical care that examines and tracks cognitive function, while also taking the positive effects of maintaining cognitive function and emulating healthy behaviours associated with higher cognitive function into account, may be one approach for protecting at-risk individuals from elevated blood glucose and subsequent type 2 diabetes mellitus.Electronic supplementary materialThe online version of this article (10.1007/s00125-018-4645-8) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

show abstract

“…Inadequate control of blood glucose in patients correlates with a higher risk for diabetes-related micro and macrovascular complications [ 4 , 5 ]. The management of diabetes aims at improving glycemic control to reduce the onset of complications [ 6 ]. Glycemic control is typically measured as reductions in glycosylated hemoglobin (HbA1c).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of vildagliptin, sitagliptin, and linagliptin as add-on therapy in Chinese patients with T2DM inadequately controlled with dual combination of insulin and traditional oral hypoglycemic agent

Tang

Wang

Jiang

et al. 2015

Diabetol Metab Syndr

View full text Add to dashboard Cite

ObjectiveWe aimed to evaluate the efficacy and safety of the three dipeptidyl peptidase 4 (DPP-4) inhibitors (vildagliptin, sitagliptin, and linagliptin) as add-on therapy in Chinese patients with type 2 diabetes mellitus (T2DM)inadequately controlled on dual combination of insulin and metformin or acarbose.MethodsA total of 535 T2DM patients who failed to achieve glycemic control with insulin and a traditional oral hypoglycemic agent were randomized to receive vildagliptin, sitagliptin, or linagliptin. Body mass index, glycosylated hemoglobin (HbA1c), fasting and postprandial plasma glucose (FPG and PPG), insulin dose, and adverse events were evaluated during the study.ResultsThe baseline HbA1c was 9.59 ± 1.84 % (vildagliptin group), 9.22 ± 1.60 % (sitagliptin group), and 9.58 ± 1.80 % (linagliptin group). At week 12 it was 8.16 ± 1.29 % (vildagliptin), 8.56 ± 1.96 % (linagliptin), and 8.26 ± 1.10 % (sitagliptin). The changes in HbA1c from baseline were −1.33 ± 0.11 % (vildagliptin), −0.84 ± 0.08 % (sitagliptin) and −0.81 ± 0.08 % (linagliptin), the vildagliptin group had the greatest reduction in HbA1c (P < 0.05). The proportions of patients that reached target HbA1c were 66.27 % (vildagliptin), 52.73 % (sitagliptin), and 55.49 % (linagliptin), the vildagliptin group had the highest one (P < 0.05). The baseline FPG and PPG values in the three groups were at the same level. At week 12, mean FPG levels in the vildagliptin (7.31 ± 1.50 mmol/L) and linagliptin (6.90 ± 1.55 mmol/L) groups were significantly lower than in the sitagliptin group (8.02 ± 4.48 mmol/L; P < 0.05); the linagliptin group had the lowest mean PPG followed by the vildagliptin group which was also significant lower (P = 0.000) than the sitagliptin group. Additionally, the required insulin dosage in the vildagliptin group was the lowest among the groups at weeks 6 and 12. Only mild AEs were reported during the study.ConclusionThe three DPP-4 inhibitors appear to be effective and safe as add-on therapy for T2DM patients on dual combination of insulin and a traditional OHA. Vildagliptin was more effective in decreasing insulin requirement and achieving glycemic control when compared to the other two.

show abstract

Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes

Cited by 21 publications

References 37 publications

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Cognitive function in early and later life is associated with blood glucose in older individuals: analysis of the Lothian Birth Cohort of 1936

Efficacy and safety of vildagliptin, sitagliptin, and linagliptin as add-on therapy in Chinese patients with T2DM inadequately controlled with dual combination of insulin and traditional oral hypoglycemic agent

Contact Info

Product

Resources

About