TY - JOUR
T1 - The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia
T2 - The ARIC study
AU - Rawlings, Andreea M.
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
N1 - Publisher Copyright:
© 2019 by the American Diabetes Association.
PY - 2019
Y1 - 2019
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.
UR - http://www.scopus.com/inward/record.url?scp=85068547630&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068547630&partnerID=8YFLogxK
U2 - 10.2337/dc19-0120
DO - 10.2337/dc19-0120
M3 - Article
C2 - 31221696
AN - SCOPUS:85068547630
SN - 0149-5992
VL - 42
SP - 1248
EP - 1264
JO - Diabetes care
JF - Diabetes care
IS - 7
ER -