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Glucose variability tied to cognitive decline, dementia risk
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Glucose peaks above approximately 180 mg/dL in adults with diabetes are associated with risks for cognitive decline and dementia over more than 20 years, according to findings published in Diabetes Care.
Elizabeth Selvin, PhD, Andreea Rawlings, PhD, MS, both of the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues evaluated data from the Atherosclerosis Risk in Communities (ARIC) study on 12,835 adults (mean age, 57 years; 56% women; 24% black) with and without diabetes to determine the association of glucose peaks in midlife with the risk for dementia and 20-year cognitive decline. Glucose peaks were determined by measures of 1,5-anhydroglucitol (1,5-AG), a monosaccharide whose level is highly inversely correlated with glucose level and hyperglycemia in diabetes over approximately 2 to 14 days, according to the researchers.
Overall, 1,105 participants developed dementia during a follow-up of 21 years.
Among participants with poorly controlled diabetes (HbA1c 7%), dementia risk was 86% higher among those with 1,5-AG concentrations less than 10 µg/mL compared with higher concentrations (P = .011). Among participants with well-controlled diabetes (HbA1c < 7%), the risk for dementia was 33% higher among participants with 1,5-AG concentration less than 10 µg/mL compared with higher concentrations, although this did not reach statistical significance. Mode led continuously, each 5 µg/mL decrease in 1,5-AG in participants with diabetes was associated with a 16% increase in risk for dementia by 16% (P = .032). The risk for dementia did not significantly differ among participants without diabetes regardless of 1,5-AG concentrations.
Among participants with well-controlled diabetes, the z score for cognitive decline was 0.19 greater in participants with 1,5-AG concentration less than 10 µg/mL compared with higher concentrations (P = .162). Among participants with poorly diabetes, the z score for cognitive decline was 0.38 greater in participants with 1,5-AG concentrations less than 10 µg/mL compared with higher concentrations (P < .001).
“Glycemic variability — large swings in glucose — may be important to improving health outcomes, including cognitive health,” Selvin and Rawlings told Endocrine Today. “Health care providers and their patients should potentially pay attention to variability in glucose control in addition to focusing on control of average glucose. We need better measures that can tell us about glucose variability and an understanding of exactly how glycemic variability may impact cognitive health and other clinical outcomes.” – by Amber Cox
For more information:
Andreea Rawlings, PhD, MS, can be reached at arawlin2@jhu.edu.
Disclosure: The researchers report no relevant financial disclosures.
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