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

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2010 Jun 25

PMID 20573753

Citations 85

Authors

Maria Rosaria Rizzo

Raffaele Marfella

Michelangela Barbieri

Virginia Boccardi

Francesco Vestini

Biagio Lettieri

Silvestro Canonico

Giuseppe Paolisso

Affiliations

Soon will be listed here.

Abstract

Objective: The 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 Methods: In 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).

Results: MAGE 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.

Conclusions: MAGE 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.

Citing Articles

Continuous Glucose Monitoring in Comorbid Dementia and Diabetes: The Evidence So Far.

Ergin B, Gadsby-Davis K, Mattishent K, Dhatariya K, Garner N, Hornberger M J Diabetes Sci Technol. 2024; :19322968241301058.

PMID: 39691964 PMC: 11653377. DOI: 10.1177/19322968241301058.

Association of time in range with cognitive impairment in middle-aged type 2 diabetic patients.

Liu Y, Liu Y, Qiu H, Haghbin N, Li J, Li Y BMC Endocr Disord. 2024; 24(1):241.

PMID: 39516758 PMC: 11546570. DOI: 10.1186/s12902-024-01772-5.

Impact of blood glucose on cognitive function in insulin resistance: novel insights from ambulatory assessment.

Gruber J, Ruf A, Suss E, Tariverdian S, Ahrens K, Schiweck C Nutr Diabetes. 2024; 14(1):74.

PMID: 39261457 PMC: 11390747. DOI: 10.1038/s41387-024-00331-0.

A High-Carbohydrate Diet Induces Cognitive Impairment and Promotes Amyloid Burden and Tau Phosphorylation via PI3K/Akt/GSK-3β Pathway in db/db Mice.

Xu J, Xie L, Yin J, Shi X, Dong K, Tao J Biomedicines. 2024; 12(8).

PMID: 39200168 PMC: 11351503. DOI: 10.3390/biomedicines12081701.

Tirzepatide prevents neurodegeneration through multiple molecular pathways.

Fontanella R, Ghosh P, Pesapane A, Taktaz F, Puocci A, Franzese M J Transl Med. 2024; 22(1):114.

PMID: 38287296 PMC: 10823712. DOI: 10.1186/s12967-024-04927-z.

References

Klonoff D . Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005; 28(5):1231-9. DOI: 10.2337/diacare.28.5.1231. View

Ratcliff G, Dodge H, Birzescu M, Ganguli M . Tracking cognitive functioning over time: ten-year longitudinal data from a community-based study. Appl Neuropsychol. 2003; 10(2):76-88. DOI: 10.1207/S15324826AN1002_03. View

Fontbonne A, Berr C, Ducimetiere P, Alperovitch A . Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care. 2001; 24(2):366-70. DOI: 10.2337/diacare.24.2.366. View

Service F, MOLNAR G, ROSEVEAR J, ACKERMAN E, Gatewood L, Taylor W . Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes. 1970; 19(9):644-55. DOI: 10.2337/diab.19.9.644. View

Heaton R, Nelson L, Thompson D, Burks J, Franklin G . Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. J Consult Clin Psychol. 1985; 53(1):103-10. DOI: 10.1037//0022-006x.53.1.103. View

Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol J . Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006; 295(14):1681-7. DOI: 10.1001/jama.295.14.1681. View

Abbatecola A, Rizzo M, Barbieri M, Grella R, Arciello A, Laieta M . Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics. Neurology. 2006; 67(2):235-40. DOI: 10.1212/01.wnl.0000224760.22802.e8. View

Grigoletto F, Zappala G, Anderson D, Lebowitz B . Norms for the Mini-Mental State Examination in a healthy population. Neurology. 1999; 53(2):315-20. DOI: 10.1212/wnl.53.2.315. View

Dickinson P, Carrington A, Frost G, Boulton A . Neurovascular disease, antioxidants and glycation in diabetes. Diabetes Metab Res Rev. 2002; 18(4):260-72. DOI: 10.1002/dmrr.305. View

10.

Cukierman-Yaffe T, Gerstein H, Williamson J, Lazar R, Lovato L, Miller M . Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009; 32(2):221-6. PMC: 2628683. DOI: 10.2337/dc08-1153. View

11.

Service F, OBrien P, Rizza R . Measurements of glucose control. Diabetes Care. 1987; 10(2):225-37. DOI: 10.2337/diacare.10.2.225. View

12.

Cox D, Kovatchev B, Gonder-Frederick L, Summers K, McCall A, Grimm K . Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes. Diabetes Care. 2004; 28(1):71-7. DOI: 10.2337/diacare.28.1.71. View

13.

Marfella R, Barbieri M, Ruggiero R, Rizzo M, Grella R, Licia Mozzillo A . Bariatric surgery reduces oxidative stress by blunting 24-h acute glucose fluctuations in type 2 diabetic obese patients. Diabetes Care. 2009; 33(2):287-9. PMC: 2809267. DOI: 10.2337/dc09-1343. View

14.

Ceriello A, Hanefeld M, Leiter L, Monnier L, Moses A, Owens D . Postprandial glucose regulation and diabetic complications. Arch Intern Med. 2004; 164(19):2090-5. DOI: 10.1001/archinte.164.19.2090. View

15.

Shorr R, de Rekeneire N, Resnick H, Yaffe K, Somes G, Kanaya A . Glycemia and cognitive function in older adults using glucose-lowering drugs. J Nutr Health Aging. 2006; 10(4):297-301. View

16.

. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes. 1995; 44(8):968-83. View

17.

Ryan C, Freed M, Rood J, Cobitz A, Waterhouse B, Strachan M . Improving metabolic control leads to better working memory in adults with type 2 diabetes. Diabetes Care. 2006; 29(2):345-51. DOI: 10.2337/diacare.29.02.06.dc05-1626. View

18.

Monnier L, Lapinski H, Colette C . Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care. 2003; 26(3):881-5. DOI: 10.2337/diacare.26.3.881. View

19.

Carlesimo G, Caltagirone C, Gainotti G . The Mental Deterioration Battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the Standardization of the Mental Deterioration Battery. Eur Neurol. 1996; 36(6):378-84. DOI: 10.1159/000117297. View

20.

Mussell M, Hewer W, Kulzer B, Bergis K, Rist F . Effects of improved glycaemic control maintained for 3 months on cognitive function in patients with Type 2 diabetes. Diabet Med. 2004; 21(11):1253-6. DOI: 10.1111/j.1464-5491.2004.01322.x. View