Abstract P339: Glycemic Excursions and Cognitive Function in Older Adults With Diabetes

Abstract

Introduction: The association between glucose excursions and cognitive function in older adults with diabetes is not well described. 1,5-anhydroglucitol (1,5-AG) is a novel biomarker of hyperglycemic excursions. Low 1,5-AG levels reflect blood glucose concentrations exceeding the renal filtration threshold (~180 mg/dl) over the prior 1-2 weeks. Our aim was to test the hypothesis that glucose excursions, as measured by 1,5-AG, were associated with lower cognitive function in older adults with diabetes. Methods: We conducted a cross-sectional analysis of 2000 participants with diabetes from ARIC visit 5 (2011-2013). Diabetes was defined based on self-reported physician diagnosis, diabetes medication use, or HbA1c ≥6.5%. Eleven neuropsychological tests were summarized using Z scores and were grouped into three cognitive domains representing memory, executive function, and language; a global measure of cognitive function was also calculated by averaging and standardizing scores from all tests. 1,5-AG was dichotomized at 10 μg/mL, with values <10 μg/mL reflecting glycemic excursions. Participants were categorized into one of four groups based on 1,5-AG categories and glycemic control (HbA1c <7% vs ≥7%). We used linear regression and adjusted for demographic and clinical characteristics. Results: The mean age of participants was 75 years, 57% were female, and 78% were white. For persons with HbA1c ≥7%, the adjusted differences in cognitive scores comparing 1,5-AG <10 to 1,5-AG ≥10 ug/mL were significantly lower in all domains except memory (Figure). For persons with HbA1c <7%, there were no significant differences in cognitive scores between 1,5-AG categories. Conclusions: Short-term glucose excursions are independently associated with lower cognitive scores in older adults with diabetes and with poor glycemic control (HbA1c ≥7%). Prospective studies are needed to determine if targeting hyperglycemic excursions can improve cognitive function in older adults with diabetes.