Relationships Between Daily Acute Glucose Fluctuations and Cognitive Performance Among Aged Type 2 Diabetic Patients

Abstract

OBJECTIVEThe mean amplitude of glycemic excursions (MAGE) is a significant determinant of overall metabolic control as well as increased risk for diabetes complications. Older individuals with type 2 diabetes are more likely to have moderate cognitive deficits and structural changes in brain tissue. Considering that poor metabolic control is considered a deranging factor for cognitive performance in diabetic patients, we evaluated whether the contributions of MAGE to cognitive status in older patients with type 2 diabetes were independent from the main markers of glycemic control, such as sustained chronic hyperglycemia (A1C), postprandial glycemia (PPG), and fasting plasma glucose (FPG).RESEARCH DESIGN AND METHODSIn 121 older patients with type 2 diabetes, 48-h continuous subcutaneous glucose monitoring (CSGM) were assessed. MAGE and PPG were evaluated during CSGM. The relationship of MAGE to performance on cognitive tests was assessed, with adjustment for age, glycemic control markers, and other determinants of cognitive status. The cognitive tests were a composite score of executive and attention functioning and the Mini Mental Status Examination (MMSE).RESULTSMAGE was significantly correlated with MMSE (r = 0.83; P < 0.001) and with cognition composite score (r = 0.68; P < 0.001). Moreover, MAGE was associated with the MMSE (P < 0.001) and cognition composite score (P < 0.001) independently of age, sex, BMI, waist-to-hip (WHR) ratio, drug intake, physical activity, mean arterial blood pressure, FPG, PPG, and A1C.CONCLUSIONSMAGE during a daily period was associated with an impairment of cognitive functioning independent of A1C, FPG, and PPG. The present data suggest that interventional trials in older patients with type 2 diabetes should target not only A1C, PPG, and FPG but also daily acute glucose swings.

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

“…However, this association between A1C and cognitive function was not observed in another large prospective cohort study (26). Small studies have also evaluated the impact of glucose excursions on cognitive function and found an association between the diurnal variation and postprandial elevation of glucose levels with a cognitive decline (27,28). Some preliminary data suggest short-term improvement of cognitive function in patients with type 2 diabetes treated with intranasal insulin via the impact on anterior brain vasodilatation (29).…”

Self-Monitoring of Blood Glucose in Type 2 Diabetes: Recent Studies

“…20 The importance of SMBG in T2DM is also underlined by growing evidence that glycemic variability independently increases the risk for endothelial dysfunction, cognitive impairment, vascular complications, and mortality. [21][22][23][24] It is currently hypothesized that glycemic variability contributes to diabetes complications independently of glycosylated hemoglobin (HbA1c) levels. [24][25][26] To assess diurnal glucose excursions, SMBG has also been established as a useful tool.…”

Degludec is superior to glargine in terms of daily glycemic variability in people with type 1 diabetes mellitus

“…Fasting blood samples were taken before and after the study. and was recently reported to correlate closely with cognition level and oxidative stress in vivo [15,16]. It is worth evaluating the difference in daily blood glucose variability between Deg and Gla using CGM systems.…”