Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics

Abbatecola, Angela Marie; Rizzo, Maria Rosaria; Barbieri, Michelangela; Grella, Rodolfo; Arciello, Alessandro; Laieta, Maria Teresa; Acampora, R; Passariello, N.; Cacciapuoti, Federico; Paolisso, Giuseppe

doi:10.1212/01.wnl.0000224760.22802.e8

Cited by 146 publications

(98 citation statements)

References 34 publications

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“…We also found that patients with dementia had significantly higher PPG and lower FPG levels, whereas no differences were found for A1c compared with patients without dementia ( Table 1). These findings are to some extent in accordance with previous articles underlining that cognitive abilities are significantly poorer due to transient glucose excursions caused by treatment-induced hypoglycemia 18,19 or experimentally produced hyperglycemia. 20 Unfortunately, our protocol did not allow testing for glucose excursions.…”

Section: Discussionsupporting

confidence: 93%

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Abbatecola¹,

Barbagallo

et al. 2015

Journal of the American Medical Directors Association

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Section: Discussionsupporting

confidence: 93%

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Abbatecola¹,

Barbagallo

et al. 2015

Journal of the American Medical Directors Association

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“…16 Abbatecola et al 146 report a randomised trial comparing repaglinide and glibenclamide. The main outcome measure was cognitive function, with the hypothesis being the tighter control of postprandial PG would reduce cognitive decline, in patients aged 60-78 years, mean age 74 years.…”

Section: Evidence On Repaglinidementioning

confidence: 99%

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Johnston

Uthman

Cummins

et al. 2017

Health Technol Assess

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Background Most people with type 2 diabetes are overweight, so initial treatment is aimed at reducing weight and increasing physical activity. Even modest weight loss can improve control of blood glucose. If drug treatment is necessary, the drug of first choice is metformin. However, some people cannot tolerate metformin, which causes diarrhoea in about 10%, and it cannot be used in people with renal impairment. This review appraises three of the newest class of drugs for monotherapy when metformin cannot be used, the sodium–glucose co-transporter 2 (SGLT2) inhibitors. Objective To review the clinical effectiveness and cost-effectiveness of dapagliflozin (Farxiga, Bristol-Myers Squibb, Luton, UK), canagliflozin (Invokana, Janssen, High Wycombe, UK) and empagliflozin (Jardiance, Boehringer Ingelheim, Ingelheim, Germany/Eli Lilly and Company, Indianapolis, IN, USA), in monotherapy in people who cannot take metformin. Sources MEDLINE (1946 to February 2015) and EMBASE (1974 to February 2015) for randomised controlled trials lasting 24 weeks or more. For adverse events, a wider range of studies was used. Three manufacturers provided submissions. Methods Systematic review and economic evaluation. A network meta-analysis was carried out involving the three SGLT2 inhibitors and key comparators. Critical appraisal of submissions from three manufacturers. Results We included three trials of dapagliflozin and two each for canagliflozin and empagliflozin. The trials were of good quality. The canagliflozin and dapagliflozin trials compared them with placebo, but the two empagliflozin trials included active comparators. All three drugs were shown to be effective in improving glycaemic control, promoting weight loss and lowering blood pressure (BP). Limitations There were no head-to-head trials of the different flozins, and no long-term data on cardiovascular outcomes in this group of patients. Most trials were against placebo. The trials were done in patient groups that were not always comparable, for example in baseline glycated haemoglobin or body mass index. Data on elderly patients were lacking. Conclusions Dapagliflozin, canagliflozin and empagliflozin are effective in improving glycaemic control, with added benefits of some reductions in BP and weight. Adverse effects are urinary and genital tract infections in a small proportion of users. In monotherapy, the three drugs do not appear cost-effective compared with gliclazide or pioglitazone, but may be competitive against sitagliptin (Januvia, Merck Sharp & Dohme Limited, Kenilworth, NJ, USA). Funding The National Institute for Health Research Health Technology Assessment programme.

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“…In a study that randomly assigned 156 older patients with diabetes to two different oral anti-diabetic agents, higher postprandial plasma glucose excursions (less tight diabetes control) were associated with greater declines in cognitive performance measures over one year of follow-up. 9 An inverse correlation has been noted between some cognitive measures and hemoglobin A1c levels, also suggesting that worse glycemic control may be associated with greater cognitive decline.…”

Section: Resultsmentioning

confidence: 99%

Study of mild cognitive impairment by applying Kolkata cognitive screening battery in type 2 diabetes mellitus patients in India

et al. 2016

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Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics

Abstract: Exaggerated postprandial glucose (PPG) excursions are associated with a derangement of both global, executive, and attention functioning. A tighter control of PPG may prevent cognitive decline in older diabetic individuals.

Cited by 146 publications

References 34 publications

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Study of mild cognitive impairment by applying Kolkata cognitive screening battery in type 2 diabetes mellitus patients in India

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