The Journal of Clinical Endocrinology and Metabolism Journal Article

Physiological Markers and Cognition in T2DM

December 14, 2020
 

Owen T Carmichael, Rebecca H Neiberg, Gareth R Dutton, Kathleen M Hayden, Edward Horton, F Xavier Pi-Sunyer, Karen C Johnson, Stephen R Rapp, Adam P Spira, Mark A Espeland
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 12, December 2020, Pages e4778–e4791
https://doi.org/10.1210/clinem/dgaa591

Abstract

Context

The effects of physiological improvements on cognitive function among persons with type 2 diabetes mellitus (T2DM) are not fully understood.

Objective

To determine whether improvements in physiological markers (body weight, blood sugar control, and physical activity) during intensive lifestyle intervention (ILI) are associated with enhancements in cognitive function in older adults with T2DM.

Design

Multisite randomized controlled trial.

Setting

Academic research centers.

Patients or Other Participants

Participants were aged 45–76 years, with T2DM.

Intervention

The Action for Health in Diabetes (Look AHEAD) study, a randomized, controlled clinical trial of ILI.

Main Outcome Measure

Two to 3 cognitive assessments were collected from 1089 participants, the first and last occurring a mean (standard deviation) of 8.6 (1.0) and 11.5 (0.7) years after enrollment.

Results

Greater improvement in blood sugar control was associated with better cognitive scores (fasting glucose and Rey Auditory Verbal Learning Test [AVLT]: P = 0.0148; fasting glucose and Digit Symbol Coding (DSC): P = 0.0360; HbA1C and DSC: P = 0.0477); but weight loss had mixed associations with cognitive scores (greater body mass index [BMI] reduction and worse AVLT overall: P = 0.0053; and greater BMI reduction and better DSC scores among those overweight but not obese at baseline: P = 0.010). Associations were strongest among those who were overweight (not obese) at baseline, and among those with a history of cardiovascular disease (CVD) at baseline.

Conclusions

Improvements in glycemic control, but not necessarily weight status, during ILI may be associated with better subsequent cognitive performance. These associations may differ by adiposity and CVD history.

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