Mark B. Zimering, Jeffrey Knight, Ling Ge, Gideon Bahn, the VADT Investigators, Jeremy Soule, Susan Caulder, Clare Pittman, Omayra Alston, Ronald K. Mayfield, Greg Moffitt, Julius Sagel, Frank Sanacor, Elizabeth Ganaway, Jennifer Marks, Lorraine Okur, Lucille Jones, Hermes Florez, Donna Pfeifer, Luis Samos, Andrew L. Taylor, Mark B. Zimering, Adilia Sama, Frances Rosenberg, Heidi Garcia, Norman Ertel, Leonard Pogach, J. Shin John, Felice Caldarella, Constantino Carseli, Mamta Shah, Paulette Ginier, George Arakel, Yangheng Fu, Don Tayloe, Jack E. Allen, Elizabeth Fox, Paula G. Hensley, Nicholas Emanuele, Kathleen Kahsen, Patricia Linnerud, Lily Agrawal, Nasrin Azad, Marco Marcelli, Glenn R. Cunningham, Natalie M. Nichols, Emilia Cordero, Rabih Hijazi, Farid Roman, Paromita Datta, Mariana Garcia Touza, Amale Lteif, Karen L. Moore, Christina Lazar-Robinson, Sanjay Gupta, M. Sue Kirkman, Martha Mendez, Zehra Haider, Lora Risley, Dennis Karounos, Linda Barber, Janet Hibbard, James W. Anderson, L. Raymond Reynolds, Jeff Carlsen, Robert W. Collins, As’ad Ehtisham, Moti L. Kashyap, Barbara Matheus, Tina Rahbarnia, Anthony N. Vo, Nancy Downey, Lynette Fox, Richard M. Gonzales, C. Daniel Meyers, Subramaniam Tavintharan, Frank Q. Nuttall, Lisa Cupersmith, Kathy Dardick, Linda Kollman, Angeliki Georgopoulos, Catherine Niewoehner, Stephen N. Davis, Paula Harper, Diana Davis, Jessica Devin, Annis Marney, Julia Passyn-Dunn, Jennifer Perkins, John Stafford, Al Powers, Linda Balch, Patricia Harris, Robert J. Anderson, Diana Dunning, Steve Ludwig, Marlene Vogel, Cyrus DeSouza, Robert Ecklund, Sarah Doran, Claire Korolchuk, Mary McElmeel, Sarah Wagstaff, Peter Reaven, Bradley Solie, John Matchette, Christian Meyer, Sylvia Vela, Nadeem Aslam, Eliot Brinton, Joy Clark, Alisa Domb, Linda McDonald, Lynae Shurtz, R. Harsha Rao, Janice N. Beattie, Carol Franko, Frederick R. DeRubertis, David Kelly, Melisse Maser, Juleen Paul, Franklin Zieve, Susan J. Clark, Ann Grimsdale, Sonja Fredrickson, James Levy, Diane Schroeder, Ali Iranmanesh, Barbara Dunn, Donna Arsura, Csaba Kovesdy, Suzanne Hanna, Ashraf Iranmanesh, Christy Florow, Fe Remandaban, Erica Smith, Robert R. Henry, Miriam Keller, Vanita Aroda, Charles Choe, Steven Edelman, Andrea Gasper, Dereck MaFong, Sunder Mudaliar, Deborah Oh, Rahil Bandukwala, Anna Chang, Sandeep Chaudhary, Sithophol Chinnapongse, Louie Christiansen, Neelima Chu, Dennis Kim, Mark Lupo, Manju Chandra, Ray Plodkowski, Roopa Sathyaprakash, Janet Wilson, Joseph Yu, Gina Macaraeg, Shelley Townes, Ralph DeFronzo, Lisa Johnson, Ken Cusi, Devjit Tripathy, Mandeep Bajaj, Janet Blodgett, Sangeeta Kayshup, Mary Helen Vasquez, Barbara Walz, Tess Weaver, Julio Benabe, Zuleika Mercado, Brunilda Padilla, Jocelyn Serrano-Rodriguez, Carlos Rosado, Edwin Mejias, Tania Tejera, Clorinda Geldrez, Elda Gonzalez-Melendez, Maria Natal, Jimenez Maribel Rios, Jayendra H. Shah, Wendy S. Wendel, Lynnette Scott, Lynne A. Gurnsey, Fabia A. Kwiecinski, Thomas Boyden, Merilyn G. Goldschmidt, Virginia Easton
Abstract
Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years) from the Veterans Affairs Diabetes Trial.
A battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.
The mean age-adjusted DSym or TMT-B declined significantly in all study participants (P < 0.001). Randomized INT glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057), lower baseline diastolic blood pressure (BP; beta = 0.028; P = 0.002), and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic BPs. Baseline thiazide diuretic use (beta = -0.549; P = 0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic BP-lowering was significantly associated (P < 0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride-lowering (P = 0.045) and decline in digit symbol substitution task performance.
A 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides appeared as modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.
Pharmacology, Toxicology and Pharmaceutical Science
2
8%
Nursing and Health Professions
1
4%
Other
4
16%
Unknown
8
32%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 September 2016.
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#21,295,789
of 26,150,873 outputs
Outputs from Frontiers in endocrinology
#7,009
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Outputs of similar age
#270,001
of 345,637 outputs
Outputs of similar age from Frontiers in endocrinology
#25
of 39 outputs
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