The prevalence of mild cognitive impairment with type 2 diabetes mellitus among elderly people in China: A cross-sectional study

H4K12 lactylation potentiates mitochondrial oxidative stress via the Foxo1 pathway in diabetes-induced cognitive impairment

AIMS

To investigate the role and potential mechanisms of H4K12 lactylation modifications in diabetes-related cognitive impairment (DACD).

METHODS

Behavioral tests, HE staining, and immunohistochemistry were employed to assess cognitive function and the extent of brain tissue injury. Metabolomics and proteomics were applied to profile the metabolic regulatory network. We measured lactic acid and Pan-Kla levels in the brains of T2DM mice and high glucose-treated microglia. CUT&Tag technology was utilized to identify genes regulated by H4K12la. Small interfering RNA (siRNA) sequences and adeno-associated viruses (AAVs) were used to knock down key components in signaling pathways, evaluating the impact of histone lactylation on microglial polarization.

RESULTS

Lactic acid levels were significantly higher in the brains of T2DM mice and high glucose-treated microglia compared to controls, leading to an increase in pan histone lysine lactylation (Kla). We found that lactate directly induced an increase in H4K12la. CUT&Tag analysis revealed that elevated H4K12la activates the FOXO1/PGC-1α signaling pathway by enhancing binding to the FOXO1 promoter, promoting mitochondrial oxidative stress.

CONCLUSION

This study demonstrated that elevated H4K12la directly activates the FOXO1 signaling pathway, promoting oxidative stress and contributing to DACD phenotypes.

Association between glycated hemoglobin A1c levels, control status, and cognitive function in type 2 diabetes: a prospective cohort study

Cognitive impairment (CI) is a common complication in patients with type 2 diabetes mellitus (T2DM), but its relationship with long-term glycemic control remains unclear. This study aimed to investigate the associations between mean hemoglobin A1c (HbA1c) levels, HbA1c control status, HbA1c fluctuations, and CI in Chinese adults aged 45 years and older with T2DM using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 797 participants with HbA1c measurements from 2011 to 2015 and cognitive function assessments in 2018 were included. Logistic regression models and restricted cubic spline (RCS) analysis were applied, adjusting for potential confounders. Higher mean HbA1c levels (≥ 9%) were significantly associated with an increased risk of CI, particularly in global cognition and episodic memory (OR 4.03 (1.45-11.20) for global cognition; OR 2.92 (1.02-8.38) for episodic memory). RCS analysis revealed a U-shaped relationship between mean HbA1c and CI, indicating that both excessively low and high HbA1c levels elevate CI risk. Uncontrolled HbA1c levels (≥ 8%) were also linked to higher CI risk compared to stable HbA1c levels. Maintaining HbA1c levels below 8% may significantly reduce CI risk in T2DM patients, highlighting the importance of personalized glycemic management.

Association of time in range with cognitive impairment in middle-aged type 2 diabetic patients

OBJECTIVE

This study investigated the association of Time In Range (TIR) obtained from Blood Glucose Monitoring (BGM) with Cognitive Impairment (CI) inpatients with middle-aged Type 2 Diabetes Mellitus (T2DM) and further explored whether a TIR goal for T2DM in adults with > 70% possess a protective effect on cognitive function.

RESEARCH DESIGN AND METHODS

A total of 274 inpatients with T2DM aged 40-64 years, who underwent seven-point BGM ( pre meals and 120 min post meals and at bedtime) were recruited in this cross-sectional study. TIR was defined as the percentage of blood glucose within the target range of 3.9-10.0mmol/L. Subjects were divided into Normal Cognitive Function (NCF) (n = 160) and CI (n = 114) groups according to the results of the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). The association of TIR and other glycemic metrics, calculated from seven-point BGM data, with cognitive dysfunction was analyzed.

RESULTS

The prevalence of CI was 41.6% in patients with middle-aged T2DM (median age 58 years). TIR was lower in CI group than in NCF group (28.6% vs. 42.9%, P = 0.004). The prevalence of CI decreased with ascending tertiles of TIR (p for trend < 0.05). Binary logistic regression analysis showed a significant association between TIR and CI (odds ratio [OR] = 0.84, p < 0.001) after adjusting for confounders (age, education, marital status, age at Diabetes Mellitus (DM) onset, cerebrovascular disease). Further adjustment of Standard Deviation (SD)(OR = 0.84, p = 0.001) or Coefficient of Variation (CV)(OR = 0.83, p < 0.001), TIR was still associated with CI. While a TIR goal of > 70% probably possessed independent protective effect on cognitive function (OR = 0.25, p = 0.001) after controlling for confounders above.

CONCLUSIONS

TIR obtained from BGM was related to CI in middle-aged T2DM individuals and a TIR goal of > 70% probably possessed a protective effect on cognitive function for middle-aged T2DM .

Cognitive impairment and associated factors among patients with diabetes mellitus in Africa: a systematic review and meta-analysis

Background

Inappropriate management of blood sugar in patients with diabetes mellitus leads to micro-vascular and macro-vascular complications, subsequently leading to high morbidity and mortality rates. In addition, diabetes independently increases the occurrence of cognitive impairment complicated by dementia. Scientific evidence on the magnitude of cognitive impairment will provide a sound basis for the determination of healthcare needs and the planning of effective healthcare services. Despite this, there are no comprehensive data on the prevalence and associated factors of cognitive impairment among patients with diabetes in Africa.

Methods

To identify relevant articles for this review, we searched PubMed, Cochrane Library, Science Direct, African Journals Online, and Google Scholar. After extraction, the data were imported into Stata software version 11 (Stata Corp., TX, USA) for further analysis. The random-effects model, specifically the DerSimonian and Laird (D+L) pooled estimation method, was used due to the high heterogeneity between the included articles. Begg's and Egger's regression tests were used to determine the evidence of publication bias. Sub-group analyses and sensitivity analyses were also conducted to handle heterogeneity.

Results

The pooled prevalence of cognitive impairment among patients with diabetes in Africa is found to be 43.99% (95% CI: 30.15-57.83, p < 0.001). According to our analysis, primary level of education [pooled odds ratio (POR) = 6.08, 95% CI: 3.57-10.36, I 2 = 40.7%], poorly controlled diabetes mellitus (POR = 5.85, 95% CI: 1.64-20.92, I 2 = 87.8%), age above 60 years old (POR = 3.83, 95% 95% CI: 1.36-10.79, I 2 = 63.7%), and diabetes duration greater than 10 years (POR = 1.13; 95% CI: 1.07-1.19, I 2 = 0.0%) were factors associated with cognitive impairment among patients with diabetes.

Conclusion

Based on our systematic review, individuals with diabetes mellitus exhibit a substantial prevalence rate (43.99%) of cognitive impairment. Cognitive impairment was found to be associated with factors such as primary level of education, poorly controlled diabetes mellitus, age above 60 years, and diabetes duration greater than 10 years. Developing suitable risk assessment tools is crucial to address uncontrolled hyperglycemia effectively.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024561484.

Association between pre-diabetes or diabetes and cognitive impairment in a community-dwelling older population: Bushehr Elderly Health (BEH) program

Background

Persistent uncontrolled hyperglycemia is recognized as one of the risk factors for cognitive disorders. Accordingly, both type 1 and type 2 diabetes may predispose individuals to cognitive impairment, particularly in cases where glycemic control is insufficient. The objective of this comprehensive study is to separately assess cognitive dysfunctions in diabetic and non-diabetic older adults.

Methods

This cross-sectional study is part of phase 2 of the Bushehr elderly health program (BEHP). Cognitive function was evaluated using the Mini-cog and categorical verbal fluency tests (CFTs). Patients were classified as non-diabetics, pre-diabetics, or diabetics based on the diagnostic criteria for diabetes mellitus (DM). To compare the means of the two groups, we utilized the t-test or the Mann-Whitney test. Additionally Multivariable logistic regression models were used to determine the association between pre-diabetes or DM and cognitive impairment.

Results

Out of 1533 participants, 693 (45.2%) were identified as having cognitive impairment. The average hemoglobin A1C was higher in participants with cognitive impairment compared to those without cognitive impairment. (5.8 ± 1.6% vs. 5.5 ± 1.4%, P = 0.004). Furthermore, the mean blood glucose levels were found to be more elevated in cases of cognitive impairment (108.0 ± 47.4 mg/dL vs. 102.1 ± 0.35 mg/dL, P = 0.002). After adjusting for age, gender, body mass index (BMI), waist circumference, amount of physical activity, and smoking, the multivariable logistic regression model, declared an association between diabetes and cognitive impairment (OR = 1.48, P = 0.003). In addition, older patients, females, widows, and individuals with elevated LDL-Cs and those with high blood pressure were found to be more vulnerable to cognitive impairment.

Conclusion

The Bushehr Elderly Health Program (BEHP) study revealed that individuals affected with cognitive impairment may exhibit higher levels of HbA1c. This suggests a positive correlation between elevated HbA1c and cognitive impairment.

Study of cognitive functions and their association with depression in type II diabetes mellitus

Introduction

Individuals with diabetes have higher risk of developing depression, cognitive impairment, and dementia compared to those who do not have diabetes. The present study aims to assess the level of cognitive functions and the presence of depression in diabetes patients and healthy controls. The study also explores the level of cognition among the normal control, diabetes without depression, and diabetes with depression.

Methods

In the present study, the presence of depression and the level of cognitive functions of 59 cases of diabetes mellitus type-2 were compared with an age- and gender-matched control group of 40 individuals. Clinical and demographic details were recorded on a semi-structured performa. Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9) were applied to both diabetes patients and healthy controls to assess the level of cognitive functions and the presence of depression, respectively.

Results

On applying odds ratio (OR), it was observed in the present study that there were 93.50% more chances [OR 1.935 with 95% confidence interval (CI) being 0.481-7.789] of depression among diabetic cases as compared to the control group. Similarly, the chance of MoCA score being less than 26 was twice among the diabetic group as compared to the control group (OR 2.208 with 95% CI being 0.702-6.946). On application of the Chi-square test, the association of depression was significant with HBA1C level, level of education, and presence of complications.

Conclusions

Patients with diabetes had almost double the risk of developing depression and poor cognitive functions as compared to the healthy control. High HbA1C level, level of education, and presence of complication in diabetes had a positive statistical association with depression. Thus, it is advisable to investigate patients with diabetes for the presence of depression and cognitive dysfunction by applying simple tools.

Reliability and validity of a novel mobile-based automatic battery of cognitive tests in healthy young Chinese adults

PURPOSE

To evaluate the reliability and validity of a newly developed computerized Automated Battery of Cognitive Tests in healthy individuals without cognitive impairments or psychiatric disorders.

METHODS

From April 20 to July 1, 2023, 142 healthy individuals in Beijing and Tangshan, China were assessed using the Automated Battery of Cognitive Tests. After a 3-week interval, 36 participants were randomly selected for retesting. The assessment also included administration of the Repeatable Battery for the Assessment of Neuropsychological Status and the Automated Battery of Cognitive Tests to 59 participants.

RESULTS

The Automated Battery of Cognitive Tests consists of 16 subtests. Internal consistency reliability was 0.75. The test-retest reliability for each factor ranged from 0.337 to 0.850 (p < 0.05). The criterion-related validity, as measured by correlation with the total Repeatable Battery for the Assessment of Neuropsychological Status score, was 0.748 (p < 0.001). The cumulative variance contribution rate is 70.109%. The results of the confirmatory factor analysis indicated a good model fit.

CONCLUSIONS

The computerized Automated Battery of Cognitive Tests is a cognitive self-assessment tool with good reliability and validity. It can evaluate multiple aspects of cognitive performance in healthy individuals and is suitable for self-administration through remote access via Internet.

HIF-1α serves as a co-linker between AD and T2DM

Alzheimer's disease (AD)-related brain deterioration is linked to the type 2 diabetes mellitus (T2DM) features hyperglycemia, hyperinsulinemia, and insulin resistance. Hypoxia as a common risk factor for both AD and T2DM. Hypoxia-inducible factor-1 alpha (HIF-1α) acts as the main regulator of the hypoxia response and may be a key target in the comorbidity of AD and T2DM. HIF-1α expression is closely related to hyperglycemia, insulin resistance, and inflammation. Tissue oxygen consumption disrupts HIF-1α homeostasis, leading to increased reactive oxygen species levels and the inhibition of insulin receptor pathway activity, causing neuroinflammation, insulin resistance, abnormal Aβ deposition, and tau hyperphosphorylation. HIF-1α activation also leads to the deposition of Aβ by promoting the abnormal shearing of amyloid precursor protein and inhibiting the degradation of Aβ, and it promotes tau hyperphosphorylation by activating oxidative stress and the activation of astrocytes, which further exasperates AD. Therefore, we believe that HIF-α has great potential as a target for the treatment of AD. Importantly, the intracellular homeostasis of HIF-1α is a more crucial factor than its expression level.

Reprogramming astrocytic NDRG2/NF-κB/C3 signaling restores the diabetes-associated cognitive dysfunction

BACKGROUND

Dementia is a serious complication in patients with diabetes-associated cognitive dysfunction (DACD). In this study, we aim to explore the protective effect of exercise on DACD in diabetic mice, and the role of NDRG2 as a potential guarder for reversing the pathological structure of neuronal synapses.

METHODS

Seven weeks of standardized exercise at moderate intensity was carried out using an animal treadmill in the vehicle + Run and STZ + Run groups. Based on quantitative transcriptome and tandem mass tag (TMT) proteome sequencing, weighted gene co-expression analysis (WGCNA) and gene set enrichment analysis (GSEA) were used to investigate the activation of complement cascades to injury neuronal synaptic plasticity. Golgi staining, Western blotting, immunofluorescence staining, and electrophysiology were used to verify the reliability of sequencing data. The role of NDRG2 was assessed by overexpressing or inhibiting the NDRG2 gene in vivo. Moreover, we estimated the cognitive function in diabetic or normal patients using DSST scores.

FINDINGS

Exercise reversed the injury of neuronal synaptic plasticity and the downregulation of astrocytic NDRG2 in diabetic mice, which succeeded in attenuating DACD. The deficiency of NDRG2 aggravated the activation of complement C3 by accelerating the phosphorylation of NF-κB, ultimately leading to synaptic injury and cognitive dysfunction. Conversely, the overexpression of NDRG2 promoted astrocytic remodeling by inhibiting complement C3, thus attenuating synaptic injury and cognitive dysfunction. Meanwhile, C3aR blockade rescued dendritic spines loss and cognitive deficits in diabetic mice. Moreover, the average DSST score of diabetic patients was significantly lower than that of non-diabetic peers. Levels of complement C3 in human serum were elevated in diabetic patients compared to those in non-diabetic patients.

INTERPRETATION

Our findings illustrate the effectiveness and integrative mechanism of NDRG2-induced improvement of cognition from a multi-omics perspective. Additionally, they confirm that the expression of NDRG2 is closely related to cognitive function in diabetic mice and the activation of complement cascades accelerated impairment of neuronal synaptic plasticity. NDRG2 acts as a regulator of astrocytic-neuronal interaction via NF-κB/C3/C3aR signaling to restore synaptic function in diabetic mice.

FUNDING

This study was supported by the National Natural Science Foundation of China (No. 81974540, 81801899, 81971290), the Key Research and Development Program of Shaanxi (Program No. 2022ZDLSF02-09) and Fundamental Research Funds for the Central Universities (Grant No. xzy022019020).

Research Progress on Lipocalin-2 in Diabetic Encephalopathy

Diabetic encephalopathy is a central nervous complication of diabetes mellitus which is characterized by cognitive impairment and structural and neurochemical abnormalities, which is easily neglected. Lipocalin-2 (LCN2) is a 25 kDa transporter in the lipocalin family that can transport small molecules, including fatty acids, iron, steroids, and lipopolysaccharides in the circulation. Recently, LCN2 has been found to be a significant regulator of insulin resistance and glucose homeostasis. Numerous studies have shown that LCN2 is connected to central nervous system abnormalities, including neuroinflammation and neurodegeneration, while the latest researches have found that LCN2 is closely related to the development of diabetic encephalopathy. Nevertheless, its precise role in the pathogenesis of diabetic encephalopathy remains to be determined. In this paper, we review recent evidence on the role of LCN2 in diabetic encephalopathy from multiple perspectives in order to decipher the impact of LCN2 in both the aetiology and treatment of diabetic encephalopathy.

Acute bouts of aerobic and resistance exercise similarly alter inhibitory control and response time while inversely modifying plasma BDNF concentrations in middle-aged and older adults with type 2 diabetes

Impairments in several domains of cognitive functions are observed in people with Type 2 Diabetes Mellitus (T2DM), often accompanied by low Brain-derived neurotrophic factor (BDNF) concentrations. Although aerobic and resistance exercise enhances cognitive functions and raises BDNF concentrations in several populations, it remained uncertain in T2DM subjects. This study compared the effects of a single bout of aerobic (AER, 40 min of treadmill walk at 90-95% of the maximum walk speed) or resistance (RES, 3 × 10 repetitions in eight exercises at 70% of 10-RM) exercise on specific cognitive domain performance and plasma BDNF concentrations of physically active T2DM subjects. Eleven T2DM subjects (9 women/2 men; 63 ± 7 years) performed two counterbalanced trials on non-consecutive days. Stroop Color and Word (SCW) task [assessing the attention (congruent condition) and inhibitory control (incongruent condition)], Visual response time (assessing the response time), and blood collection (for plasma BDNF concentrations) were performed pre and post-exercise sessions. With distinct magnitude, both AER and RES improved the incongruent-SCW (d = - 0.26 vs. - 0.43 in AER and RES, respectively; p < 0.05), RT_(best) (d = - 0.31 vs. - 0.52, p < 0.05), and RT_(1-5) (d = - 0.64 vs. - 0.21, p < 0.05). The congruent-SCW and RT_(6-10) were not statistically different. Plasma BDNF concentrations were elevated 11% in AER (d = 0.30) but decreased by 15% in RES (d = - 0.43). A single session of aerobic or resistance exercise similarly improved the inhibitory control and response time of physically active T2DM subjects. Nevertheless, aerobic and resistance exercise sessions induced an opposite clinical effect in plasma BDNF concentrations.

Systematic evaluation of the prevalence of cognitive impairment in elderly patients with diabetes in China

OBJECTIVE

To systematically evaluate the prevalence of cognitive impairment in elderly patients with diabetes in China.

METHODS

Computerized searches of the Chinese Biomedical, WanFang, Vip, Chinese National Knowledge Infrastructure, PubMed, Embase, and the Cochrane Library databases were used to collect research literature on cognitive impairment in older Chinese patients with diabetes from the time of database creation to May 5, 2021. A meta-analysis was performed using the Stata v14.0 software after two investigators independently screened the literature, extracted the information, and evaluated the bias risk of the included studies.

RESULTS

A total of 17 studies containing the records of 4380 elderly patients with diabetes were included. The meta-analysis results showed that the incidence of cognitive impairment in elderly patients with diabetes was 48% (95% confidence interval [0.40-0.55]). The results of the subgroup analysis showed that the incidence of cognitive impairment was higher in the elderly population with diabetes who were female, older, with a lower education level, no spouse, living alone, and with a monthly income of less than 2000 yuan.

CONCLUSION

Current evidence showed that the incidence of cognitive impairment in elderly patients with diabetes in China was 48%, with a higher incidence in the elderly population who were female, older, with a lower education level, a low income, no spouse, and living alone.

Cognitive impairment with Type 2 Diabetes Mellitus among community-dwelling older adults in Chile: Prevalence, risk factors and cognitive characteristics

Introduction

The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group.

Methodology

A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student's t-tests and MANOVA.

Results

Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, p < 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between "cognition" and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group.

Conclusion

The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.

Sigma-1 Receptor as a Protective Factor for Diabetes-Associated Cognitive Dysfunction via Regulating Astrocytic Endoplasmic Reticulum-Mitochondrion Contact and Endoplasmic Reticulum Stress

The prevalence of diabetes-associated cognitive dysfunction (DACD) has increased to 13.5%. Dementia, as the most severe DACD, is the second leading cause of death in patients with diabetes mellitus. Hence, the potential mechanisms of DACD for slowing or halting its progression need to be urgently explored. Given that the sigma-1 receptor (Sig-1R), a chaperone protein located in the endoplasmic reticulum (ER)-mitochondrion contact membranes to regulate ER stress (ERS), is associated with cognitive outcomes in neurodegenerative diseases, this study aimed to investigate the role of astrocytic Sig-1R in DACD and its underlying mechanism. Here, we examined the levels of ERS and complement component 3/3a (C3/C3a) from primary astrocytes with different concentrations of glucose and treatment. Subsequently, HT22 neurons were cultured in different astrocyte-conditioned medium, and the expression of synaptic proteins was detected. We constructed type 1 diabetes mellitus (T1DM) model to evaluate the astrocytic Sig-1R mechanism on synapse and cognitive function changes. In vitro, high glucose concentration downregulated Sig-1R and aggravated ERS in astrocytes, resulting in synapse deficits. PRE-084, a high-affinity and selective Sig-1R agonist, inhibited astrocytic ERS and complement cascades and restored synaptic damage, while the Sig-1R antagonist displayed the opposite results. Moreover, C3a receptor antagonist (C3aRA) could mimic the effect of PRE-084 and exerted neuroprotective effects. In vivo, PRE-084 substantially reduced ER-mitochondrion contact, activation of ERS, and C3/C3a secretion in mice with T1DM. Additionally, the synaptic loss and neurobehavioral dysfunction of mice with T1DM were less pronounced in both the PRE-084 and C3aRA treatment groups. These findings demonstrated that Sig-1R activation reduced the astrocytic ER-mitochondrion contact, ERS activation, and complement-mediated synaptic damage in T1DM. This study suggested the mechanisms and potential therapeutic approaches for treating DACD.

MRI-based machine learning model: A potential modality for predicting cognitive dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is a crucial risk factor for cognitive impairment. Accurate assessment of patients' cognitive function and early intervention is helpful to improve patient's quality of life. At present, neuropsychiatric screening tests is often used to perform this task in clinical practice. However, it may have poor repeatability. Moreover, several studies revealed that machine learning (ML) models can effectively assess cognitive impairment in Alzheimer's disease (AD) patients. We investigated whether we could develop an MRI-based ML model to evaluate the cognitive state of patients with T2DM. Objective: To propose MRI-based ML models and assess their performance to predict cognitive dysfunction in patients with type 2 diabetes mellitus (T2DM). Methods: Fluid Attenuated Inversion Recovery (FLAIR) of magnetic resonance images (MRI) were derived from 122 patients with T2DM. Cognitive function was assessed using the Chinese version of the Montréal Cognitive Assessment Scale-B (MoCA-B). Patients with T2DM were separated into the Dementia (DM) group (n = 40), MCI group (n = 52), and normal cognitive state (N) group (n = 30), according to the MoCA scores. Radiomics features were extracted from MR images with the Radcloud platform. The variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) were used for the feature selection. Based on the selected features, the ML models were constructed with three classifiers, k-NearestNeighbor (KNN), Support Vector Machine (SVM), and Logistic Regression (LR), and the validation method was used to improve the effectiveness of the model. The area under the receiver operating characteristic curve (ROC) determined the appearance of the classification. The optimal classifier was determined by the principle of maximizing the Youden index. Results: 1,409 features were extracted and reduced to 13 features as the optimal discriminators to build the radiomics model. In the validation set, ROC curves revealed that the LR classifier had the best predictive performance, with an area under the curve (AUC) of 0.831 in DM, 0.883 in MIC, and 0.904 in the N group, compared with the SVM and KNN classifiers. Conclusion: MRI-based ML models have the potential to predict cognitive dysfunction in patients with T2DM. Compared with the SVM and KNN, the LR algorithm showed the best performance.

Population-attributable fractions of risk factors for all-cause dementia in China rural and urban areas: a cross-sectional study

BACKGROUND

The prevalence of dementia in China, particularly in rural areas, is consistently increasing; however, research on population-attributable fractions (PAFs) of risk factors for dementia is scarce.

METHODS

We conducted a cross-sectional survey, namely, the China Multicentre Dementia Survey (CMDS) in selected rural and urban areas from 2018 to 2020. We performed face-to-face interviews and neuropsychological and clinical assessments to reach a consensus on dementia diagnosis. Prevalence and weighted PAFs of eight modifiable risk factors (six classical: less childhood education, hearing impairment, depression, physical inactivity, diabetes, and social isolation, and two novels: olfactory decline and being unmarried) for all-cause dementia were estimated.

RESULTS

Overall, CMDS included 17,589 respondents aged ≥ 65 years, 55.6% of whom were rural residents. The age- and sex-adjusted prevalence for all-cause dementia was 9.11% (95% CI 8.96-9.26), 5.19% (5.07-5.31), and 11.98% (11.8-12.15) in the whole, urban, and rural areas of China, respectively. Further, the overall weighted PAFs of the eight potentially modifiable risk factors were 53.72% (95% CI 52.73-54.71), 50.64% (49.4-51.89), and 56.54% (55.62-57.46) in the whole, urban, and rural areas of China, respectively. The eight risk factors' prevalence differed between rural and urban areas. Lower childhood education (PAF: 13.92%) and physical inactivity (16.99%) were primary risk factors in rural and urban areas, respectively.

CONCLUSIONS

The substantial urban-rural disparities in the prevalence of dementia and its risk factors exist, suggesting the requirement of resident-specific dementia-prevention strategies.

Altered Structural and Functional MRI Connectivity in Type 2 Diabetes Mellitus Related Cognitive Impairment: A Review

Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment in many domains. There are several pieces of evidence that changes in neuronal neuropathies and metabolism have been observed in T2DM. Structural and functional MRI shows that abnormal connections and synchronization occur in T2DM brain circuits and related networks. Neuroplasticity and energy metabolism appear to be principal effector systems, which may be related to amyloid beta (Aβ) deposition, although there is no unified explanation that includes the complex etiology of T2DM with cognitive impairment. Herein, we assume that cognitive impairment in diabetes may lead to abnormalities in neuroplasticity and energy metabolism in the brain, and those reflected to MRI structural connectivity and functional connectivity, respectively.

Increased Serum Trimethylamine N-Oxide Level in Type 2 Diabetic Patients with Mild Cognitive Impairment

PURPOSE

Trimethylamine N-oxide (TMAO) is a metabolite of phosphatidylcholine in red meat and other diets, which is associated with cardiovascular and other diseases. The aim of this study is to evaluate the associations of serum TMAO with mild cognitive impairment (MCI) in the Chinese type 2 diabetes mellitus (T2DM) population.

MATERIALS AND METHODS

A total of 253 hospitalized T2DM patients and 150 healthy controls were included in this cross-sectional study. Montreal Cognitive Assessment (MoCA) assessed the cognition function, and the 253 T2DM patients were divided into 74 subjects with MCI and 179 with non-MCI. Demographic data and biochemical test results were evaluated. Serum TMAO level was measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).

RESULTS

A higher serum TMAO level was observed in T2DM patients compared with the healthy controls (P < 0.001). Among all T2DM patients, the MCI group (n = 74) showed higher serum TMAO levels than the non-MCI group. Spearman correlation test showed that TMAO levels were significantly positively correlated with age (r = 0.147, P = 0.019), body mass index (BMI) (r = 0.153, P = 0.015), diabetes duration (r = 0.160, P = 0.011), HbA1c (r = 0.138, P = 0.029), triglyceride (TG) (r = 0.138, P = 0.029), creatinine (r = 0.184, p = 0.003), hs-CRP (r = 0.243, P < 0.001), and were negatively correlated with HDL-C (r = -0.144, P = 0.022), BDNF (r = -0.165, p = 0.009), and MoCA (r = -0.386, P < 0.001) score (all P < 0.05). Multivariable Logistic regression identified high serum TMAO level as a significant independent factor of MCI in the T2DM patients (OR = 1.404, 95% CI = 1.255-1.571; P < 0.001).

CONCLUSION

Our study showed that T2DM patients with MCI have elevated serum TMAO levels.

Equity in the Provision of Diabetes Self-Management Education and Support

Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority. The authors discuss how best to tailor DSMES to meet the needs of these diverse groups.

Is resveratrol a prospective therapeutic strategy in the co-association of glucose metabolism disorders and neurodegenerative diseases?

Objectives: The mechanism behind the progression of Mild Cognitive Impairment (MCI) to Alzheimer's disease (AD) remains poorly understood. However some evidence pointed out that the co-occurrence of metabolic conditions affecting glucose homeostasis, as type 2 diabetes mellitus (T2DM), may be an important catalyst in this context. Notably, candidate drugs which modulate common pathways in the development of MCI-to-AD mediated by T2DM may offer likely therapy for AD. Nonetheless, limited pharmacological alternatives that modulate common pathways in T2DM, MCI, and AD are available. In the recent decades, studies have shown that resveratrol may act as a neuroprotective compound, but little is known about its potential in improving cognitive and metabolic aspects associated with AD progression mediated by the co-association between TDM2-MCI.Methods: In this review, we discuss possible protective mechanisms of resveratrol on shared pathways associated with AD progression mediated by T2DM-MCI co-occurrence.Results: Some studies indicated that insulin resistance and hyperglycemia may be also a T2DM risk factor for the progression of MCI-to-AD, promoting alterations in metabolic pathways associated with neuronal plasticity, and increasing pro-inflammatory environment. Interestingly, basic research and clinical trials indicate that resveratrol may modulate those pathways, showing a potential neuroprotective effect of this polyphenol.Conclusion: Therefore, there is not enough clinical data supporting the translational therapeutic use of resveratrol in this scenario.

Association of cognitive impairment with sleep quality, depression and cardiometabolic risk factors in individuals with type 2 diabetes mellitus: A cross sectional study

AIM

The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus.

METHODS

Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with anthropometric and biochemical measurements. A detailed neuropsychological assessment [Montreal cognitive assessment scale (MoCA), Trail making A and B, Digit span, Spatial span, Letter Number Sequencing] was done. Cognitive impairment was defined as MoCA score of <23.

RESULTS

Participants (n=250, 50% women, 63.6% middle-age) had a mean (±SD) age of 53.6 (±9.1) years and HbA1c of 55.1±6.8mmol/mol (7.2±0.6%). Cognitive impairment was present in 57 (22.8%) participants. In the middle-age subgroup, cognitive impairment was higher (23.9%) than those in the fourth decade (6.3%), but comparable (24.0%) to the older age (60-70years) individuals. Diabetes-related vascular complications [Odds ratio (95% CI) 2.03 (1.05, 3.94)]; hypertension [2.00 (1.04, 3.84)], depression [2.37 (1.24, 4.55)] and lower education [2.73 (1.42, 5.23)] had a significant association with cognitive impairment on multivariate logistic regression analysis.

CONCLUSION

The high burden of cognitive impairment calls for an urgent need to establish longitudinal cohorts in midlife to understand this population's cognitive trajectories and see the influence of various bio-psychosocial variables.

The prevalence of mild cognitive impairment in type 2 diabetes mellitus patients: a systematic review and meta-analysis

AIMS

Mild Cognitive impairment (MCI) is common in type 2 diabetes mellitus (T2DM) patients. The impaired cognitive function had harmful effect on patients' diabetic conditions. This study aimed to estimate the prevalence of MCI in T2DM (T2DM-MCI) patients by conducting a systematic review and meta-analysis of observational studies.

METHODS

We carried out a literature search until June 1, 2020, for all observational studies in the following databases: Medline (PubMed), Web of Science, and Embase. Two independent reviewers initially screened the eligible articles. Then, a meta-analysis (random effects model) was conducted to estimate the prevalence of MCI in people with T2DM with STATA 16.

RESULTS

A total of 1808 articles were first considered after reading title and abstract, 12 of which remained after reviewing the full text. The combined prevalence of MCI in T2DM patients was estimated to be 45.0% (95% CI=36.0, 54.0). There was no significant heterogeneity through meta-regression and sensitivity analysis. Overall, Europe (n=2, r=36.6%, 95% CI=26.3, 46.9, I²=82.3%) had a lower prevalence than Asia (n=10, r=46.4%, 95% CI=36.2, 56.6, I²=98%). The overall prevalence in female patients (n=14, r=46.9%, 95% CI=34, 59.8, I²=98.3%) was higher than that in male patients (n=14, r=38.8%, 95% CI=27, 50.7, I²=98%). Subgroup analysis based on age demonstrated a lower prevalence in patients older than 60 years (n=9, r=44.3%, 95% CI=33.1, 55.6, I²=98.3%) than patients younger than 60 years (n=3, r=46.4%, 95% CI=33.3, 59.5, I²=91.2%).

CONCLUSION

Our results demonstrate that the pooled estimated prevalence of mild cognitive impairment in type 2 diabetes mellitus patients is high worldwide, especially in China Asia. Primary care clinicians should pay more attention to the cognitive function of T2DM patients, as mild cognitive impairment is one of the risk factors for Alzheimer's disease.

Mitochondrial Dysfunction and Mitophagy Closely Cooperate in Neurological Deficits Associated with Alzheimer's Disease and Type 2 Diabetes

Alzheimer's disease (AD) and type 2 diabetes (T2D) are known to be correlated in terms of their epidemiology, histopathology, and molecular and biochemical characteristics. The prevalence of T2D leading to AD is approximately 50-70%. Moreover, AD is often considered type III diabetes because of the common risk factors. Uncontrolled T2D may affect the brain, leading to memory and learning deficits in patients. In addition, metabolic disorders and impaired oxidative phosphorylation in AD and T2D patients suggest that mitochondrial dysfunction is involved in both diseases. The dysregulation of pathways involved in maintaining mitochondrial dynamics, biogenesis and mitophagy are responsible for exacerbating the impact of hyperglycemia on the brain and neurodegeneration under T2D conditions. The first section of this review describes the recent views on mitochondrial dysfunction that connect these two disease conditions, as the pathways are observed to overlap. The second section of the review highlights the importance of different mitochondrial miRNAs (mitomiRs) involved in the regulation of mitochondrial dynamics and their association with the pathogenesis of T2D and AD. Therefore, targeting mitochondrial biogenesis and mitophagy pathways, along with the use of mitomiRs, could be a potent therapeutic strategy for T2D-related AD. The last section of the review highlights the known drugs targeting mitochondrial function for the treatment of both disease conditions.

Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

BACKGROUND

Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients.

METHODS

The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed.

RESULTS

Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients' race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies.

CONCLUSIONS

Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

Cognitive Impairment and Related Factors Among Middle-Aged and Elderly Patients with Type 2 Diabetes from a Bio-Psycho-Social Perspective

OBJECTIVE

This study investigated the biomedical, psychological, and social behavior risk factors for cognitive impairment in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional study included 240 patients with T2DM. A questionnaire was used to collect demographic and disease-related data on patients, and the Self-rating Depression Scale (SDS), Diabetes Self-care Scale (DSCS), and Social Support Rating Scale (SSRS) were used to assess patients' depression status, self-management behavior, and social support, respectively. The Chinese version of the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function, with a score <26 set as the threshold for cognitive impairment.

RESULTS

The prevalence of cognitive dysfunction in middle-aged and elderly patients with T2DM was 52.5%. Multivariate logistic regression analysis showed that older age, a history of hypoglycemia within 1 month, and depression were independent risk factors for cognitive impairment. Education for >12 years, urban living, and a higher total score on the DSCS were independent protective factors against cognitive impairment.

CONCLUSION

T2DM patients with high risk of cognitive impairment can be identified early from the bio-psycho-social perspective. Patients with T2DM who are older, less educated, living in rural areas, have hypoglycemia history, and have poor self-management of diabetes are at increased risk of cognitive impairment. Closer monitoring of patients with hypoglycemia, early detection of depression, and improving patients' self-management capacity can prevent cognitive impairment in middle-aged and elderly patients with T2DM.

Association of Serum Melatonin Level with Mild Cognitive Impairment in Type 2 Diabetic Patients: A Cross-Sectional Study

OBJECTIVES

Melatonin is an essential neuroendocrine hormone that participates in the regulation of sleep rhythm and cognitive function. This study aimed to determine serum melatonin levels with mild cognitive impairment (MCI) in patients with type 2 diabetes (T2DM).

METHODS

A total of 247 T2DM patients were recruited in this retrospective study and divided into 75 subjects with MCI and 172 with normal cognition. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Their blood sample was examined for the level of melatonin and other biochemical parameters.

RESULTS

Melatonin concentration was decreased in MCI patients to non-MCI patients (P < 0.001). Melatonin level was negatively correlated with age (r = -0.202; P = 0.001), diabetes duration (r = -0.282; P < 0.001), serum HbA1c (r = -0.195; P = 0.002), hs-CRP (r = -0.324; P < 0.001), and TSH (r = -0.184; P = 0.004) levels and positively correlated with MoCA score, serum HDL-C (r = 0.145; P < 0.001), FT3 (r = 0.241; P < 0.001), and FT4 (r = 0.169; P = 0.008) levels. The multivariable analysis indicated that fewer years of formal education, longer diabetes duration, higher serum HbA1c, higher serum hs-CRP, and lower serum melatonin are the predisposing factors for MCI.

CONCLUSION

Lower melatonin level was associated with cognitive impairment in patients with T2DM. Melatonin might serve as a potential protective molecule against cognitive dysfunction in T2DM.

Prevalence of Psychiatric Morbidity and Cognitive Impairment among Patients Attending the Rural Noncommunicable Disease Clinic

Objective  This study aimed to assess the prevalence of cognitive impairment and psychiatric morbidity among the patients attending the rural noncommunicable disease clinic after controlling for various confounders (i.e., psychological morbidity, obesity, gender, level of education, duration of the illness and age).

Materials and Methods  One-hundred twenty-four patients were evaluated on the Hindi Mental State Examination for the cognitive function, Physical Health Questionnaire-9 for depression, and Generalized Anxiety Disorder-7 for anxiety disorders.

Results  About one-fourth (26.6%) of the participants had cognitive impairment. The prevalence of cognitive impairment was more among patients with hypertension (35.5%) as compared with the diabetes mellitus (13.6%) and those with comorbid hypertension and diabetes mellitus (26.6%). About one of the participants had depression (35.5%) and 29% of the patients had anxiety disorder. No significant difference was found in the level of cognitive deficits between those with hypertension and diabetes mellitus, when the confounding factors were not taken into account in the analysis. However, after controlling for psychiatric morbidity, obesity, gender, level of education, duration of the illness and age, those with hypertension were found to have significantly higher level of cognitive impairment compared with those with diabetes mellitus. A higher level of dysfunction was seen in the domains of orientation, registration, attention, recall, language, and visuospatial domains.

Conclusion  Present study suggests that patients of hypertension have higher level of cognitive impairment, when compared with those with diabetes mellitus, even after controlling for various confounders. Lack of difference between the two groups can be accounted by the confounding variables.

Clinical Applicability of the Specific Risk Score of Dementia in Type 2 Diabetes in the Identification of Patients with Early Cognitive Impairment: Results of the MOPEAD Study in Spain

Introduction: Although the Diabetes Specific Dementia Risk Score (DSDRS) was proposed for predicting risk of dementia at 10 years, its usefulness as a screening tool is unknown. For this purpose, the European consortium MOPEAD included the DSDRS within the specific strategy for screening of cognitive impairment in type 2 diabetes (T2D) patients attended in a third-level hospital. Material and Methods: T2D patients > 65 years, without known cognitive impairment, attended in a third-level hospital, were evaluated. As per MOPEAD protocol, patients with MMSE ≤ 27 or DSDRS ≥ 7 were referred to the memory clinic for complete neuropsychological assessment. Results: 112 T2D patients were recruited. A total of 82 fulfilled the criteria for referral to the memory unit (43 of them declined referral: 48.8% for associated comorbidities, 37.2% lack of interest, 13.95% lack of social support). At the Fundació ACE’s Memory Clinic, 34 cases (87.2%) of mild cognitive impairment (MCI) and 3 cases (7.7%) of dementia were diagnosed. The predictive value of DSDRS ≥ 7 as a screening tool of cognitive impairment was AUROC = 0.739, p 0.024, CI 95% (0.609–0.825). Conclusions: We found a high prevalence of unknown cognitive impairment in TD2 patients who attended a third-level hospital. The DSDRS was found to be a useful screening tool. The presence of associated comorbidities was the main factor of declining referral.

Depressive Symptoms are Associated with High Levels of Serum Low-Density Lipoprotein Cholesterol in Older Adults with Type 2 Diabetes Mellitus

Fundamento

O Diabetes Mellitus Tipo 2 (DMT2) é comum nos idosos, que também apresentam um nível elevado de fatores de risco para doenças cardiovasculares (DCVs), tais como dislipidemia. Entretanto, o papel da depressão nos pacientes com DMT2 e sua relação com fatores de risco para DCV são pouco estudados.

Objetivo

O objetivo do presente estudo foi investigar a relação entre sintomas depressivos (SDs) e fatores de risco cardiovascular conhecidos em idosos comunitários portadores de DMT2.

Métodos

Trata-se de um estudo transversal, no qual foram incluídos 85 idosos comunitários com DMT2. Os SDs foram avaliados através da Escala de Depressão Geriátrica de Yesavage, em versão reduzida (GDS-15). Os seguintes fatores de risco cardiovascular foram avaliados: pressão arterial sistólica (PAS) e diastólica (PAD), glicose plasmática em jejum (GPJ), perfil lipídico (triglicerídeos séricos (TG), colesterol total sérico (CT), colesterol sérico de lipoproteína de baixa densidade (LDL-C) e colesterol sérico de lipoproteína de baixa densidade (HDL-C)) e índice de massa corporal (IMC). A análise de regressão múltipla de Poisson foi utilizada para avaliar a associação entre os SDs e cada fator de risco cardiovascular ajustado por sexo, idade, tempo em atividades físicas moderadas e status funcional. O nível de significância adotado para a análise foi de 5%.

Resultados

Dentre todos os fatores de risco analisados, apenas o aumento de LDL-C apresentou uma correlação com níveis elevados de SD (RP=1,005; IC95% 1,002-1,008). Foi observada uma associação significativa entre os níveis de HDL-C (RP=0,99; IC95% 0,98-0,99) e a PAS (RP=1,009; IC95% 1,004-1,014).

Conclusão

Nos idosos com DMT2, a presença de SD foi associada a níveis de LDL-C, HDL-C e PAS, mesmo após o ajuste por sexo, idade, nível de atividade física e capacidade funcional. (Arq Bras Cardiol. 2020; 115(3):462-467)

Screening for cognitive impairment among the elderly attending the noncommunicable diseases clinics in a rural area of Punjab, North India

BACKGROUND

Amongst all the ailments among the elderly persons, cognitive impairment has significant impact on the quality of life. Non-communicable diseases (NCDs) like diabetes and hypertension increase the risk of cognitive impairment and dementia. Little is known about the prevalence and correlates of cognitive impairment in elderly with NCDs.

AIM

The present study aimed to evaluate the prevalence and correlates of cognitive impairment among elderly patients living with NCDs.

METHODOLOGY

297 patients attending the chronic disease clinic of two Community Health Centres were evaluated using Hindi mini-mental scale (HMSE), University of California Los Angeles Loneliness Scale (UCLA LS), Geriatric Depression Scale, Generalized Anxiety Disorder (GAD-7 scale) and Vulnerability to Abuse Screening Scale.

RESULTS

More than one-fourth (27.3 %) of participants had cognitive impairment as per the HMSE scores. The mean HMSE score was lowest (23.90+6.61) among patients with hypertension followed by patients with diabetes alone (26.90+4.46). People with hypertension had lower mean scores on all the domains of HMSE. Multivariable binary logistic regression depicted younger age, high education status, per capita income, long duration of diseases, loneliness, and hypertension emerged as the significant risk factors associated with cognitive impairment.

CONCLUSION

Older adults with non-communicable diseases have high prevalence of cognitive impairment. Physicians should make the patients and their family members aware about the association of non-communicable diseases with cognitive impairments and should encourage these persons to use remedial measures to reduce the risk of future development of dementia.

Triad of impairment in older people with diabetes-reciprocal relations and clinical implications

Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.

Glycated Haemoglobin Is Associated With Poorer Cognitive Performance in Patients With Recent-Onset Psychosis

BACKGROUND

Glucose abnormalities and cognitive alterations are present before the onset of schizophrenia. We aimed to study whether glucose metabolism parameters are associated with cognitive functioning in recent-onset psychosis (ROP) patients while adjusting for hypothalamic-pituitary adrenal (HPA) axis measures.

METHODS

Sixty ROP outpatients and 50 healthy subjects (HS) were studied. Cognitive function was assessed with the MATRICS Consensus Cognitive Battery. Glycated haemoglobin (HbA1_c), glucose, insulin, and C-peptide levels were determined in plasma. The HOMA-insulin resistance index was calculated. Salivary samples were obtained at home on another day to assess the cortisol awakening response and cortisol levels during the day. Univariate analyses were conducted to explore the association between glucose metabolism parameters and cognitive tasks. For those parameters that were more clearly associated with the cognitive outcome, multiple linear regression analyses were conducted to adjust for covariates. Each cognitive task was considered the dependent variable. Covariates were age, sex, education level, diagnosis, antipsychotic and benzodiazepine treatment, body mass index (BMI), smoking, and HPA axis measures. Potential interactions between diagnosis and glucose parameters were tested.

RESULTS

There were no significant differences in HPA axis measures or glucose parameters, with the exception of C-peptide (that was higher in ROP patients), between groups. ROP patients had a lower performance than HS in all cognitive tasks (p < 0.01 for all tasks). Of all glucose metabolism parameters, HbA1c levels were more clearly associated with cognitive impairment in cognitive tasks dealing with executive functions and visual memory in both ROP patients and HS. Multivariate analyses found a significant negative association between HbA1c and cognitive functioning in five cognitive tasks dealing with executive functions, visual memory and attention/vigilance (a ROP diagnosis by HbA1_c negative interaction was found in this latter cognitive domain, suggesting that HBA1_c levels are associated with impaired attention only in ROP patients).

CONCLUSIONS

Our study found that HbA1_c was negatively associated with cognitive functioning in both ROP patients and HS in tasks dealing with executive functions and visual memory. In ROP patients, HbA1_c was also associated with impaired attention. These results were independent of BMI and measures of HPA axis activity.

Non-communicable Diseases and Cognitive Impairment: Pathways and Shared Behavioral Risk Factors Among Older Chinese

Population aging has brought about a number of challenges to public health and primary health care systems due to increases in the prevalence of non-communicable diseases (NCDs). As a country with one of the largest populations globally, China is confronting a rising number of chronic NCDs including cardiometabolic related conditions. This mini-review investigates the link between NCDs and cognitive impairment through common risk factors. Identifying risk factors is important for the prevention and management of these chronic conditions. In addition, this review also identifies the role of primary health care services in reducing behavioral risk factors for NCDs and cognitive impairment. Addressing shared determinants and pathways is important in the design of public health interventions and primary health care services in China. Monitoring and management of NCD biomarkers and behavioral risk factors may also be beneficial for cognitive health among older Chinese.

Risk Factors Associated with Mild Cognitive Impairment among Apparently Healthy People and the Role of MicroRNAs

BACKGROUND:

Mild cognitive impairment (MCI) is a stage between the expected cognitive decline of normal ageing and the serious decline of dementia.

AIM:

To identify risk factors and role of miRNAs associated with mild cognitive impairment (MCI) among employees.

SUBJECTS AND METHOD:

A cross-sectional study was carried out on 186 employees aged between 40 and 65 years. Cognitive function was evaluated using ACEIII, MoCA, and Quick cognitive tests. Medical history and lifestyle were assessed. Family 132 & 134 miRNA expressions were assessed by real-time PCR.

RESULTS:

MCI was detected among 14 / 186 (7.5%). miRNA 132 expression was the only significant miRNAs to detect MCI with low sensitivity and specificity (70%). The logistic analysis revealed that higher miRNA132 expressions, low monthly intake of; vegetables, unroasted nuts, low education and higher ALT levels were predicting factors for MCI with AOR 1.1 (1.01-3.3), 1.2 (1.04-1.43), 0.8 (0.8-0.98), 2.7 (1.9-7.4) and 1.6 (1.1-2.3) respectively.

CONCLUSION:

MiRNAs expression showed low sensitivity and specificity in detecting MCI; only miRNA 132 might be used. Several modifiable factors seem to reduce the risk of MCI.

Prevalence, Influence Factors and Cognitive Characteristics of Mild Cognitive Impairment in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is considered as an independent risk factor for mild cognitive impairment (MCI). This study was performed to investigate the prevalence, influencing factors and cognitive characteristics of MCI in elderly patients with T2DM in China.

Methods: In the cross-sectional study, we performed cluster random sampling of 3,246 people age 60 years and older across the country. All participants were interviewed and screened for T2DM and MCI. A total of 341 subjects were diagnosed of MCI according to the criteria of Petersen, and a total of 256 subjects were diagnosed of T2DM by using the American Diabetes Association criteria Among the 256 T2DM people, 56 were also diagnosed with MCI. Logistic regression analyses were performed to evaluate risk and protective factor for MCI with T2DM. We also assessed their cognitive function by using the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit span, Associative Learning Test (ALT), Visual Identification Test (VIT), Verbal Fluency (VF), Wechsler Adult Intelligence Scale (WAIS)-III Block Design, WAIS-III picture completion and Auditory Verbal Learning Test (AVLT).

Results: Among the 256 T2DM patients, 56 were diagnosed with MCI, and the prevalence of MCI in T2DM was 21.8%. Multivariate logistic regression analyses showed that depression (p = 0.002, OR = 6.220, 95% CI: 2.005–19.290) was a risk factor for MCI among T2DM patients, while education (p < 0.001, OR = 0.869, 95% CI: 0.805–0.983) was a protective one. All the scores of neuropsychological tests (except for MMSE) in T2DM patients with MCI were lower than those without MCI (p < 0.05), but there was no statistical difference (p > 0.05) in neuropsychological tests between T2DM-MCI group and No-T2DM-MCI group. Linear regression analysis showed that the drug treatment of diabetes was positively correlated (t = 2.263, p = 0.025) with the total score of auditory word tests.

Conclusions: The present study suggests a high prevalence of MCI among Chinese T2DM patients. Depression is a risk factor for MCI, while education is a protective one. T2DM patients with MCI often show comprehensive cognitive impairment, and the drug treatment of diabetes might help to improve cognitive function.

[DIABDEM project: A pilot study of prevalence of cognitive impairment in diabetes mellitus in 2 Hispanic countries]

INTRODUCTION

The prevalence of chronic noncommunicable diseases such as type 2 diabetes mellitus (T2DM) and dementia increase with ageing. In this context, an association between T2DM and cognitive impairment has been described in the literature. However, there are few studies in the Hispanic population. This research project presents a pilot study that will evaluate the feasibility of the DIABDEM project that will determine the prevalence of cognitive impairment in old people with diagnosis of T2DM in Spain and Chile.

MATERIALS AND METHODS

It is a observation-based pilot study, non-experimental, descriptive-comparative and cross-sectional. The sample will involve 72 participants (39 Spaniards and 33 Chileans), 65 year-old or older, men and women, community dwelling, and who have not been previously diagnosed with dementia, with or without a T2DM diagnosis. Participants will fill in a research protocol form collecting socio-demographic and clinical data, lifestyle details, and neuropsychological variables.

EXPECTED RESULTS

This study will evaluate the feasibility of the DIABDEM project that will determine the prevalence rate of cognitive impairment in old people with T2DM. On one hand, the aim of this study will establish risk and protectors factors potentially associated with the development of cognitive impairment in T2DM. On the other hand, it is expected to identify a specific neuropsychological profile in people with T2DM, proposing later a brief and useful neuropsychological battery in order to discriminate early cognitive impairment in people with T2DM.

CONCLUSION

Findings in this pilot study will obtain greater knowledge about the feasibility of the DIABDEM project, which will provide evidence about cognitive complications in T2DM.

Assessment of comorbid mild cognitive impairment and depression in patients with type 2 diabetes mellitus

CONTEXT

Depression, mild cognitive impairment, and dementia are highly prevalent chronic conditions associated with social, medical, and economic burdens. Although there are several epidemiological studies that have reported the prevalence of mild cognitive impairment or depressive syndrome in elderly diabetic population little is known about the comorbidity of these conditions. We aimed to study the prevalence of comorbid mild cognitive impairment (MCI) and depression in patients with Type 2 diabetes mellitus and its relation to glycemic control.

MATERIALS AND METHODS

the present work was carried on 400 patients with T2DM. History taking, physical examination, laboratory investigations (with special emphasis on glycemic profile and lipid profile parameters) were done for every patient. Assessment of anxiety and depression using the HADS score and assessment of mild cognitive impairment using MoCA score were done.

RESULTS

76% of studied patients had depression of varying degrees while 56.8% of studied patients had MCI. Decreased level of HDL-cholesterol and increased HADS anxiety score were significant predictors of depression. On the other hand, increased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.

CONCLUSION

Increased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol, HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.

The role of religious coping and social support on medication adherence and quality of life among the elderly with type 2 diabetes

PURPOSE

Type 2 diabetes is a major public health issue particularly in the elderly. Religion may affect the Health Related Quality of Life (HRQoL) in such patients, mediated by factors such as religious coping and social support. This study aimed to investigate the impact of religiosity on medication adherence and HRQoL.

METHODS

793 adults (> 65 years old, 45% females) were recruited from 4 diabetes care centers and followed for 1 year. Duke University Religion Index, Spiritual Coping Strategies, Multidimensional Perceived Social Support, Medication Adherence Report Scale, WHOQOL-BREF and Diabetes-specific Quality of Life Questionnaire Module were used for assessment, as well as HbA1c and fasting blood glucose level. Using structural equation modeling, the potential paths were tested between religiosity, medication adherence and HRQoL; social support, religious coping and medication adherence served as the mediators.

RESULTS

Religious coping and social support were recognized as the significant mediators between religiosity and medication adherence (CFI = 0.983, TLI = 0.985, and RMSEA = 0.021). The relationships between religiosity and HRQoL were considerably mediated by social support, religious coping and medication adherence and these variables explained 12% and 33% of variances of generic and specific HRQoL, respectively. There was no significant direct effect of religiosity on HRQoL. HbA1c and fasting blood glucose level were successfully loaded on the latent construct of medication adherence (factor loading = 0.51 and 0.44, respectively).

CONCLUSIONS

The impact of religiosity on medication adherence and HRQoL occurs through the mediators such as religious coping and social support. Therefore, to improve the adherence to treatment and quality of life, interventions may be designed based on these mediators.

Association between Diabetes and Cognitive Function among People over 45 Years Old in China: A Cross-Sectional Study

Objectives: The aim of this study is to identify the relationship between diabetes status including characteristics of diabetes and cognition among the middle-aged and elderly population (≥45 years) in China. Methods: A sample of 8535 people who participated in the China Health and Retirement Longitudinal Study (CHARLS) from June 2011 to March 2012 was analyzed. Two cognitive domains including episodic memory and executive function were measured through questionnaires. People were classified into four groups: no diabetes, controlled diabetes, untreated diabetes, treated but uncontrolled diabetes. Weighted multiple regression model was conducted to explore the association between diabetes and cognition in full sample as well as three different age groups (45–59, 60–74, ≥75). Adjustments were made for demographics and cardiovascular risk factors. Results: After adjusting several covariates, untreated diabetes (β = −0.192, p < 0.05) was significantly associated with episodic memory. In the age group of 45–69 years, untreated diabetes (β = −0.471, p < 0.05) and HbA1c level (β = −0.074, p < 0.05) were significantly associated with episodic memory. When adjusting for cardiovascular risk factors, all correlations were non-significant. Conclusion: The cross-sectional study suggests that untreated diabetes and HbA1c are the potential risk factor for cognitive impairment, and these associations are more significant in the age group of 45–59 years old. Cardiovascular factors are important mediating factors in the pathway between diabetes and cognitive impairment. More longitudinal studies are needed to confirm these associations.

Increased Ratio of Global O-GlcNAcylation to Tau Phosphorylation at Thr212 Site Is Associated With Better Memory Function in Patients With Type 2 Diabetes

Objective: Aberrant O-GlcNAc modification has been implicated in type 2 diabetes mellitus (T2DM) and the pathogenesis of neurodegenerative diseases via competition with tau phosphorylation. We aimed to investigate the association between global O-GlcNAcylation, tau phosphorylation levels and mild cognitive impairment (MCI) in the whole blood of patients with T2DM.

Methods: Sociodemographic, clinical characteristics and cognitive performances of the enrolled T2DM subjects were extensively assessed. Global O-GlcNAcylation and tau phosphorylation levels in the whole blood were also determined using Western blot.

Results: Forty-eight T2DM subjects, including 24 with MCI and 24 with normal cognition, were enrolled in this study. Compared with cognitively normal controls, T2DM with MCI subjects displayed decreased global O-GlcNAcylation level, but increased tau phosphorylation levels (all p < 0.05). To reflect the combined effect, the ratios of global O-GlcNAcylation to tau phosphorylation levels, including specific sites, such as Ser396, Ser404, Thr212, and Thr231, were all significantly decreased in MCI subjects (all p < 0.05). Further multivariable logistic regression analysis revealed that high glycated hemoglobin A1c was an independent risk factor, whereas increased O-GlcNAc/p-T212 was an independent protective factor for MCI in patients with T2DM (odds ratio [OR] = 2.452, 95% confidence interval [CI] 1.061–5.668, p = 0.036; OR = 0.028, 95%CI 0.002–0.388, p = 0.008, respectively). With regard to each cognitive domain, O-GlcNAc/p-T212 was positively correlated with the score of Auditory Verbal Learning Test-delayed recall (r = 0.377, p = 0.010).

Conclusion: Our study suggests that increased ratio of global O-GlcNAcylation to tau phosphorylation at Thr212 site in the whole blood is associated with decreased risk of MCI, especially with better memory function in T2DM subjects.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier ChiCTR-OCC-15006060.

Insulin Resistance Is a Risk Factor for Mild Cognitive Impairment in Elderly Adults with T2DM

OBJECTIVE

The aim of this study was to investigate the clinical effects of insulin resistance (IR) in the development of mild cognitive impairment (MCI) in elderly adults with Type 2 diabetes mellitus (T2DM).

METHODS

Seventy-eight patients with T2DM were recruited and divided into MCI group (<26, n=48) and normal group (≥26, n=30) according to the Montreal Cognitive Assessment (MoCA) score. The fasting plasma glucose (FPG), HbA1c, and fasting plasma C-peptide (FPC) were examined and compared between the two groups. The Pancreatic islets function (HOMA-islet) and Insulin Resistance Index (HOMA-IR) were also calculated for the two groups. Using the HOMA-IR and HOMA-islet as the reference, the predicted values for MCI in T2DM patients were calculated by sensitivity, specificity and area under the receiver operating characteristic (ROC) curve.

RESULTS

The MoCA scores were statistically different between the MCI and control groups (23.79±1.15 vs 28.50±1.01, p<0.05). The serum FPG and FPC were 10.38±2.36 mmol/L and 0.79±0.34 ng/mL in the MCI group which were significant different from those of the control group (8.96±2.55 mmol/L and 1.04±0.38 ng/mL; p<0.05). The HOMA-IR and HOMA-islet were 10.08±2.64 and 94.67±29.12 for the MCI group and 8.16±2.46 and 130.30±38.43 for the control group; both were statistically different (p<0.05). The serum HbA1c was 11.02±2.59% and 9.37±2.00% for the MCI and control groups (significantly different with p<0.5). A significant positive correlation was found between MoCA score and HOMA-islet (rpearson=0.44; p<0.001). A significant negative correlation existed between MoCA score and serum HbA1c (r=-0.25; p=0.03). The areas under the ROC curve were 0.70 (0.57~0.82), 0.69 (0.57~0.81), 0.69 (0.57~0.80), 0.72 (0.60~0.84), 0.72 (0.60~0.84) and 0.76 (0.65~0.88) respectively for FPG, FPC, HbA1c, HOMA-IR and HOMA-islet.

CONCLUSION

Insulin resistance is a risk factor for mild cognitive impairment and can be a biomarker for prediction of MCI in patients with T2DM.

Relationships between cerebral structure and cognitive function in African Americans with type 2 diabetes

BACKGROUND

Relationships between cognitive function and brain structure remain poorly defined in African Americans with type 2 diabetes.

METHODS

Cognitive testing and cerebral magnetic resonance imaging in African Americans from the Diabetes Heart Study Memory IN Diabetes (n = 480) and Action to Control Cardiovascular Risk in Diabetes MIND (n = 104) studies were examined for associations. Cerebral gray matter volume (GMV), white matter volume (WMV) and white matter lesion volume (WMLV) and cognitive performance (Mini-mental State Exam [MMSE and 3MSE], Digit Symbol Coding (DSC), Stroop test, and Rey Auditory Verbal Learning Test) were recorded. Multivariable models adjusted for age, sex, BMI, scanner, intracranial volume, education, diabetes duration, HbA1c, LDL-cholesterol, smoking, hypertension and cardiovascular disease assessed associations between cognitive tests and brain volumes by study and meta-analysis.

RESULTS

Mean(SD) participant age was 60.1(7.9) years, diabetes duration 12.1(7.7) years, and HbA1c 8.3(1.7)%. In the fully-adjusted meta-analysis, lower GMV associated with poorer global performance on MMSE/3MSE (β̂ = 7.1 × 10-3, SE 2.4 × 10-3, p = 3.6 × 10-3), higher WMLV associated with poorer performance on DSC (β̂ = -3 × 10-2, SE 6.4 × 10-3, p = 5.2 × 10-5) and higher WMV associated with poorer MMSE/3MSE performance (β̂ = -7.1 × 10-3, SE = 2.4 × 10-3, p = 3.6 × 10-3).

CONCLUSIONS

In African Americans with diabetes, smaller GMV and increased WMLV associated with poorer performance on tests of global cognitive and executive function. These data suggest that WML burden and gray matter atrophy associate with cognitive performance independent of diabetes-related factors in this population.

The Protective Effect of Astaxanthin on Cognitive Function via Inhibition of Oxidative Stress and Inflammation in the Brains of Chronic T2DM Rats

Currently, there are no effective treatments for diabetes-related cognitive dysfunction. Astaxanthin (AST), the most powerful antioxidant in nature, exhibits diverse biological functions. In this study, we tried to explore whether AST would ameliorate cognitive dysfunction in chronic type 2 diabetes mellitus (T2DM) rats. The T2DM rat model was induced via intraperitoneal injection of streptozotocin. Forty Wistar rats were divided into a normal control group, an acute T2DM group, a chronic T2DM group, and an AST group (treated with AST at a dose of 25 mg/kg three times a week). The Morris water maze test showed that the percentage of time spent in the target quadrant of the AST group was identical to that of the chronic T2DM group, while the escape latency of the AST group was decreased in comparison to that of the chronic T2DM group. Histology of the hippocampus revealed that AST ameliorated the impairment in the neurons of diabetic rats. Western blot showed that AST could upregulate nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) expression and inhibit nuclear transcription factor kappa B (NF-κB) p65 activation in the hippocampus. We found that AST increased the level of superoxide dismutase (SOD) and decreased the level of malondialdehyde (MDA) in the hippocampus. In addition, the levels of interleukin 1 beta (IL-1β) and interleukin 6 (IL-6) were reduced in the AST group compared with those in the chronic T2DM group. The findings of this research imply that AST might inhibit oxidative stress and inflammatory responses by activating the Nrf2-ARE signaling pathway.

An Update on Type 2 Diabetes Mellitus as a Risk Factor for Dementia

With the rapidly expanding evidence on brain structural and functional changes in type 2 diabetes mellitus (T2DM) patients, there is an increasing need to update our understanding on how T2DM associates with dementia as well as the underlying pathophysiological mechanisms. A literature search of T2DM and dementia or cognition impairments was carried out in electronic databases Medline, EMBASE, and Google Scholar. In this review, the chosen evidence was limited to human subject studies only, and data on either type 1 diabetes mellitus (T1DM) or non-classified diabetes were excluded. T2DM is a risk factor for both vascular dementia (VaD) and Alzheimer's disease (AD), although AD pathological marker studies have not provided sufficient evidence. T2DM interacts additively or synergistically with many factors, including old age, hypertension, total cholesterol, and APOEɛ4 carrier status for impaired cognition functions seen in patients with T2DM. In addition, comorbid T2DM can worsen the clinical presentations of patients with either AD or VaD. In summary, T2DM increases the risk for AD through different mechanisms for VaD although some mechanisms may overlap. Tau-related neurofibrillary tangles instead of amyloid-β plaques are more likely to be the pathological biomarkers for T2DM-related dementia. Degeneration of neurons in the brain, impaired regional blood supply/metabolism, and genetic predisposition are all involved in T2DM-associated dementia or cognitive impairments.

Interactive relations of type 2 diabetes and abdominal obesity to cognitive impairment: A cross-sectional study in rural area of Xi'an in China

AIMS

Type 2 diabetes and obesity, which are frequently comorbid, have been associated with cognitive impairment. We aim to examine the potential modulating effect between obesity and diabetes on cognitive impairment.

METHODS

We recruited 865 adults (aged ≥55years) lived in a village of Xi'an in China from October 2014 to March 2015. All participants underwent biomedical and neuropsychological assessment. Relations of diabetes and abdominal obesity to cognitive impairment were examined in multiple regression models.

RESULTS

A total of 155 participants (17.9%) presented with the diagnosis of cognitive impairment. Diabetes or obesity alone wasn't significantly associated with cognitive impairment. Interaction analysis showed a significant interaction between abdominal obesity and diabetes on cognitive impairment. Stratified multivariate analysis revealed that the association between diabetes and cognitive impairment was positive in participants with abdominal obesity (OR 2.436, 95% CI 1.345-4.411, p=0.003, in diabetics with high WC, and OR 2.348, 95% CI 1.373-4.014, p=0.002, in diabetics with high WHR), but negative in those without abdominal obesity.

CONCLUSIONS

Type 2 diabetes interacts with abdominal obesity to be associated with an increased risk of cognitive impairment by more than two times.

Higher prevalence and earlier appearance of geriatric phenotypes in old adults with type 2 diabetes mellitus

AIMS

To compare the prevalence of cognitive dysfunction, depression, lower mobility performance, disability and falls in older community-dwelling individuals with type 2 diabetes mellitus (T2DM) and in controls of similar age.

METHODS

We conducted a cross-sectional study in primary health care settings in 3 semi-urban regions in Greece. Were assessed 403 community-dwelling older persons (age ≥65 years, median: 73), 198 with and 205 without diabetes. Common geriatric syndromes were studied using structured individual interviews and widely-used screening scales. An ensuing secondary analysis per age group was performed.

RESULTS

After adjusting for several confounding factors, the diabetes group presented a 2-fold greater odds of having abnormal scores in Mini Mental State Examination (95%CI: 1.2-3.4, p = 0.006), a 1.5-fold greater odds of abnormal performance in the Clock Drawing Test (95%CI: 1.0-2.4, p = 0.05) and a 2-fold greater odds of slower performance in Timed-Up-And-Go test (95%CI: 1.1-3.4, p = 0.022). In the analysis per age group, impaired cognitive and mobility performances were observed in individuals with diabetes of the younger subgroup (65-74 years), while in the older subgroup (≥75 years), those differences disappeared.

CONCLUSIONS

In a community-dwelling population aged ≥65 years, cognitive and physical fragilisation is more frequent and is observed at an earlier age in individuals with T2DM than in those without.

Comparative Effectiveness for Glycemic Control in Older Adults with Diabetes

PURPOSE OF REVIEW

To review and summarize the current data for comparative effectiveness of glycemic control in older adults.

RECENT FINDINGS

In the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show cardiovascular benefit from intensive glycemic control and show only minimal microvascular benefit. Additionally, a few studies suggest that suboptimal glycemic control can increase the risk for geriatric syndromes. Emerging research suggests similar safety and efficacy of glucose-lowering therapies in older versus younger adults.

SUMMARY

Overall, there is a paucity of data supporting the benefit of intensive glycemic control in older adults. More research is needed in this vulnerable population.