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Randomized Controlled Trial
. 2009 Feb;32(2):221-6.
doi: 10.2337/dc08-1153.

Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial

Tali Cukierman-Yaffe  1 , Hertzel C Gerstein, Jeff D Williamson, Ronald M Lazar, Laura Lovato, Michael E Miller, Laura H Coker, Anne Murray, Mark D Sullivan, Santica M Marcovina, Lenore J Launer; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial

Tali Cukierman-Yaffe et al. Diabetes Care. 2009 Feb.

Abstract

Objective: Diabetes is associated with cognitive decline and dementia. However, the relationship between the degree of hyperglycemia and cognitive status remains unclear. This was explored using baseline cognitive measures collected in the ongoing Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

Research design and methods: The relationship of A1C and fasting plasma glucose (FPG) levels to performance on four cognitive tests was assessed, adjusting for age and other determinants of cognitive status. The tests were the Digit Symbol Substitution Test (DSST), Mini Mental Status Examination (MMSE), Rey Auditory Verbal Learning Test, and Stroop Test.

Results: A statistically significant age-adjusted association was observed between the A1C level and the score on all four cognitive tests. Specifically, a 1% higher A1C value was associated with a significant 1.75-point lower DSST score (95% CI -1.22 to -2.28; P < 0.0001), a 0.20-point lower MMSE score (-0.11 to -0.28; P < 0.0001), a 0.11-point lower memory score (-0.02 to -0.19, P = 0.0142), and a worse score (i.e., 0.75 s more) on the Stroop Test (1.31-0.19, P = 0.0094). The association between the DSST score and A1C persisted in all multiple linear regression models. FPG was not associated with test performance.

Conclusions: Higher A1C levels are associated with lower cognitive function in individuals with diabetes. The effect of glucose lowering on cognitive function will be determined by the ongoing ACCORD-MIND trial.

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Figures

Figure 1
Figure 1
The associations between a 1% increase in A1C (percentage) and test scores on four different measures of cognitive function (and their 95% CIs) after adjustment for different baseline characteristics are shown. The sixth model includes all of the variables noted in Table 1. A: DSST. B: MMSE. C: Memory score (Rey Auditory Verbal Learning Test). D: Stroop Test. R2 is the percentage of the variance for each cognitive test explained by each model (including the term for A1C), and *R2 is the percentage of the variance explained by each model without the A1C term included.
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