Sex, diabetes status and cognition: findings from the study of longevity in diabetes

Moran, Chris; Gilsanz, Paola; Beeri, Michal Schnaider; Whitmer, Rachel A.; Lacy, Mary E.

doi:10.1136/bmjdrc-2020-001646

Cited by 7 publications

(15 citation statements)

References 46 publications

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“…In our examination of cognition and age-based cognitive decline, we find clear evidence of a negative, statistically significant relationship between diabetes status and cognition for both males and females. These findings echo earlier work in the field (Chatterjee et al, 2016; Elias et al, 2005; Logroscino et al, 2004; Maggi et al, 2009; Moran et al, 2021; Okereke et al, 2008; Roberts et al, 2014) and emphasize the importance of managing the social, behavioral, and clinical predictors of type 2 diabetes mellitus, regular blood glucose/A1C screenings, and proper management of type 2 diabetes across the life course. While these interventions are likely essential to improving general health and cognition among older adults at large, the sex-based differences observed in this study necessitate both direct attention and further investigation.…”

Section: Discussionsupporting

confidence: 82%

“…They find lower prevalence of cognitive impairment among women with diabetes relative to their male counterparts in their analyses of Action for Health in Diabetes data, a cross-sectional, clinical dataset (Espeland et al, 2018). Most recently, Moran et al (2021) examine the moderating role of sex in the relationship between diabetes status and cognition in mid-late life. Here, they use cross-sectional data from the Study of Longevity in Diabetes and find that, relative to men, women maintain better midlife cognition independent of diabetes status (Moran et al, 2021).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Most recently, Moran et al (2021) examine the moderating role of sex in the relationship between diabetes status and cognition in mid-late life. Here, they use cross-sectional data from the Study of Longevity in Diabetes and find that, relative to men, women maintain better midlife cognition independent of diabetes status (Moran et al, 2021). They conclude their study by emphasizing the importance of studying change in cognition over time and in older cohorts of respondents to better understand sex-based variation in the cognition–diabetes association (Moran et al, 2021).…”

Section: Literature Reviewmentioning

confidence: 99%

“…We contribute to this body of literature by directly addressing this limitation. In the current study, we examine sex-based differences in the relationship between hyperglycemia and/or diabetes and declines in cognition using a longitudinal, nationally representative sample of older adults in the United States (Biessels & Despa, 2018; Biessels & Whitmer, 2020; Moran et al, 2021). We anticipate that baseline differences among diabetic and non-diabetic adults with respect to cognition will be larger among females compared to males.…”

Section: Literature Reviewmentioning

confidence: 99%

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Cognition and Diabetes: Examining Sex Differences Using a Longitudinal Sample of Older Adults

2022

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Objectives This study aims to investigate sex-based differences in the diabetes status and cognition relationship using a representative sample of older Americans. Methods Using a sample of 19,190 females and 15,580 males from the Health and Retirement Study, we conduct mixed-effects linear regression analyses to examine sex differences in the association between diabetes and cognition over a 20-year follow-up period among older adults in the United States. Main Findings Females experience slightly steeper declines in cognition that are further exacerbated by diabetes. At age 65, females without diabetes have significantly higher cognition than males; this gap is eliminated by age 85. Among diabetics, there is no initial sex disparity, but females’ cognition becomes significantly lower than males’ over the following 20 years. Principal Conclusions Relative to males, females are particularly susceptible to diabetes-related declines in cognition with increasing age.

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Section: Discussionsupporting

confidence: 82%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Cognition and Diabetes: Examining Sex Differences Using a Longitudinal Sample of Older Adults

2022

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“…Another study showed that women with diabetes are more likely to develop all-cause dementia than men, but not by dementia subtypes [ 10 ]. However, other studies observed no interaction between sex and diabetes on dementia [ 11 – 13 ]. Thus, the sex-specific association in the relationship between T2DM and dementia subtypes may need to be further explored.…”

Section: Introductionmentioning

confidence: 93%

Sex-specific associations between diabetes and dementia: the role of age at onset of disease, insulin use and complications

et al. 2023

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Background Whether the association of type 2 diabetes (T2DM) with dementia was differed by sex remains unclear, and the roles of age at onset of disease, insulin use and diabetes’ complications in their association are unknown. Methods This study analyzed data of 447 931 participants from the UK Biobank. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between T2DM and incident dementia [all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD)]. The roles of age at onset of disease, insulin use and diabetes’ complications in their association were also analyzed. Results Compared to people with no diabetes at all, people with T2DM had increased risk of all-cause dementia (HR 2.85, 95% CI 2.56–3.17). The HRs between T2DM and AD were higher in women than men, with an RHR (95%CI) of 1.56 (1.20, 2.02). There was a trend that people who experienced T2DM before age 55 had higher risk of VD than those who had T2DM after age 55. In addition, there was a trend that T2DM had higher effect on VD that occurred before age 75 years than events that occurred after age 75. Patients with T2DM using insulin had higher risk of all-cause dementia than those without insulin, with an RHR (95%CI) of 1.54 (1.00–2.37). People with complications had doubled risk of all-cause dementia, AD and VD. Conclusions Adopting a sex-sensitive strategy to address the risk of dementia in patients with T2DM is instrumental for a precision medicine approach. Meanwhile, it is warranted to consider patients' age at onset of T2DM, insulin use status and complications conditions.

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Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes

et al. 2023

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ImportanceThe levels of glycemic control associated with the lowest risk of dementia in people with type 2 diabetes are unknown. This knowledge is critical to inform patient-centered glycemic target setting.ObjectiveTo examine the associations between cumulative exposure to various ranges of glycated hemoglobin (HbA1c) concentrations with dementia risk across sex and racial and ethnic groups and the association of current therapeutic glycemic targets with dementia risk.Design, Setting, and ParticipantsThis cohort study included members of the Kaiser Permanente Northern California integrated health care system with type 2 diabetes who were aged 50 years or older during the study period from January 1, 1996, to September 30, 2015. Individuals with fewer than 2 HbA1c measurements during the study period, prevalent dementia at baseline, or less than 3 years of follow-up were excluded. Data were analyzed from February 2020 to January 2023.ExposuresTime-updated cumulative exposure to HbA1c thresholds. At each HbA1c measurement, participants were categorized based on the percentage of their HbA1c measurements that fell into the following categories: less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, 9% to less than 10%, and 10% or more of total hemoglobin (to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01).Main Outcomes and MeasuresDementia diagnosis was identified using International Classification of Diseases, Ninth Revision codes from inpatient and outpatient encounters. Cox proportional hazards regression models estimated the association of time-varying cumulative glycemic exposure with dementia, adjusting for age, race and ethnicity, baseline health conditions, and number of HbA1c measurements.ResultsA total of 253 211 participants were included. The mean (SD) age of participants was 61.5 (9.4) years, and 53.1% were men. The mean (SD) duration of follow-up was 5.9 (4.5) years. Participants with more than 50% of HbA1c measurements at 9% to less than 10% or 10% or more had greater risk of dementia compared with those who had 50% or less of measurements in those categories (HbA1c 9% to &lt;10%: adjusted hazard ratio [aHR], 1.31 [95% CI, 1.15-1.51]; HbA1c≥10%: aHR, 1.74 [95% CI, 1.62-1.86]). By contrast, participants with more than 50% of HbA1c concentrations less than 6%, 6% to less than 7%, or 7% to less than 8% had lower risk of dementia (HbA1c&lt;6%: aHR, 0.92 [95% CI, 0.88-0.97]; HbA1c 6% to &lt;7%: aHR, 0.79 [95% CI, 0.77-0.81]; HbA1c 7% to &lt;8%: aHR, 0.93 [95% CI, 0.89-0.97]).Conclusions and RelevanceIn this study dementia risk was greatest among adults with cumulative HbA1c concentrations of 9% or more. These results support currently recommended relaxed glycemic targets for older people with type 2 diabetes.

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Sex, diabetes status and cognition: findings from the study of longevity in diabetes

Cited by 7 publications

References 46 publications

Cognition and Diabetes: Examining Sex Differences Using a Longitudinal Sample of Older Adults

Cognition and Diabetes: Examining Sex Differences Using a Longitudinal Sample of Older Adults

Sex-specific associations between diabetes and dementia: the role of age at onset of disease, insulin use and complications

Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes

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