The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: The ARIC study

Andreea M. Rawlings, A. Richey Sharrett, Marilyn S. Albert, Josef Coresh, B. Gwen Windham, Melinda C. Power, David S Knopman, Keenan Walker, Sheila Burgard, Thomas H. Mosley, Rebecca F. Gottesman, Elizabeth Selvin

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Abstract

OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS Weconducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017).Wedefined incident cognitive impairment as incident MCI or incident dementia in persons dementiafree at the index examination;wealsoexamined eachoutcomeseparately. Diabetes was defined using self-report, medications, or HbA1c ≥6.5%; poor glycemic control in persons with diabetes was defined as HbA1c ≥7%. We examined the following biomarkers of hyperglycemia: HbA1c, fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59% were female, and 21% were black. Diabetes (hazard ratio [HR] 1.14 [95% CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95% CI 1.05, 1.63]), and longer diabetes duration (≥5 vs. <5 years; HR 1.59 [95% CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA1c and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA1c. HbA1c and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.

Original languageEnglish (US)
Pages (from-to)1248-1264
Number of pages17
JournalDiabetes care
Volume42
Issue number7
DOIs
StatePublished - Jan 1 2019

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Hyperglycemia
Dementia
Atherosclerosis
Fructosamine
Biomarkers
Death Certificates
Telephone
Self Report
Cognitive Dysfunction
glycosylated serum albumin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Rawlings, A. M., Sharrett, A. R., Albert, M. S., Coresh, J., Windham, B. G., Power, M. C., ... Selvin, E. (2019). The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: The ARIC study. Diabetes care, 42(7), 1248-1264. https://doi.org/10.2337/dc19-0120

The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia : The ARIC study. / Rawlings, Andreea M.; Sharrett, A. Richey; Albert, Marilyn S.; Coresh, Josef; Windham, B. Gwen; Power, Melinda C.; Knopman, David S; Walker, Keenan; Burgard, Sheila; Mosley, Thomas H.; Gottesman, Rebecca F.; Selvin, Elizabeth.

In: Diabetes care, Vol. 42, No. 7, 01.01.2019, p. 1248-1264.

Research output: Contribution to journalArticle

Rawlings, AM, Sharrett, AR, Albert, MS, Coresh, J, Windham, BG, Power, MC, Knopman, DS, Walker, K, Burgard, S, Mosley, TH, Gottesman, RF & Selvin, E 2019, 'The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: The ARIC study', Diabetes care, vol. 42, no. 7, pp. 1248-1264. https://doi.org/10.2337/dc19-0120
Rawlings, Andreea M. ; Sharrett, A. Richey ; Albert, Marilyn S. ; Coresh, Josef ; Windham, B. Gwen ; Power, Melinda C. ; Knopman, David S ; Walker, Keenan ; Burgard, Sheila ; Mosley, Thomas H. ; Gottesman, Rebecca F. ; Selvin, Elizabeth. / The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia : The ARIC study. In: Diabetes care. 2019 ; Vol. 42, No. 7. pp. 1248-1264.
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abstract = "OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS Weconducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017).Wedefined incident cognitive impairment as incident MCI or incident dementia in persons dementiafree at the index examination;wealsoexamined eachoutcomeseparately. Diabetes was defined using self-report, medications, or HbA1c ≥6.5{\%}; poor glycemic control in persons with diabetes was defined as HbA1c ≥7{\%}. We examined the following biomarkers of hyperglycemia: HbA1c, fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59{\%} were female, and 21{\%} were black. Diabetes (hazard ratio [HR] 1.14 [95{\%} CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95{\%} CI 1.05, 1.63]), and longer diabetes duration (≥5 vs. <5 years; HR 1.59 [95{\%} CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA1c and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA1c. HbA1c and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.",
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AU - Sharrett, A. Richey

AU - Albert, Marilyn S.

AU - Coresh, Josef

AU - Windham, B. Gwen

AU - Power, Melinda C.

AU - Knopman, David S

AU - Walker, Keenan

AU - Burgard, Sheila

AU - Mosley, Thomas H.

AU - Gottesman, Rebecca F.

AU - Selvin, Elizabeth

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N2 - OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS Weconducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017).Wedefined incident cognitive impairment as incident MCI or incident dementia in persons dementiafree at the index examination;wealsoexamined eachoutcomeseparately. Diabetes was defined using self-report, medications, or HbA1c ≥6.5%; poor glycemic control in persons with diabetes was defined as HbA1c ≥7%. We examined the following biomarkers of hyperglycemia: HbA1c, fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59% were female, and 21% were black. Diabetes (hazard ratio [HR] 1.14 [95% CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95% CI 1.05, 1.63]), and longer diabetes duration (≥5 vs. <5 years; HR 1.59 [95% CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA1c and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA1c. HbA1c and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.

AB - OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS Weconducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017).Wedefined incident cognitive impairment as incident MCI or incident dementia in persons dementiafree at the index examination;wealsoexamined eachoutcomeseparately. Diabetes was defined using self-report, medications, or HbA1c ≥6.5%; poor glycemic control in persons with diabetes was defined as HbA1c ≥7%. We examined the following biomarkers of hyperglycemia: HbA1c, fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59% were female, and 21% were black. Diabetes (hazard ratio [HR] 1.14 [95% CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95% CI 1.05, 1.63]), and longer diabetes duration (≥5 vs. <5 years; HR 1.59 [95% CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA1c and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA1c. HbA1c and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.

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