EO-Diabetes group (n=156) Physical and cognitive functions in elderly obese with and without diabetes Alessandra Celli1,2, Bryan Jiang1,2, Stephen Decker1,2, Yoann Barnouin1,2, Georgia Colleluori1,2, Reina Armamento-Villareal1,2, Dennis T. Villareal1,2  1Baylor College of Medicine; 2 Center for Translational Research on Inflammatory Disease, Michael E. DeBakey VA Medical Center, Houston, TX Background- bullet one eliminate the word from DONE Bullet 2 do you need both glucose metabolism and insulin resistance? no Bullet 3 do you need this no Bullet 4 not worded well consider both diabetes and OSA are associated with endothelial dysfunction and increased PAI-1 X Hypothethesis I like to picture probably do not need to state hypertension below increase BP x Materilas and methods were the PAI-1s don postprandiaL? Fasting (am and Pm samples collected) IPGTT bullet 4 reword Glucose tolerance tests were performed at baseline and weekly. Glucose levels were measured at time 0 and 15,30,60,90, and 120 minutes after IP infusion of 1g/kg of glucose. Move the method for measuring glucose up to the glucose section BP studies for 1 week to establish baseline measurements Results I am still not a fan of stating the result in the title Why is basline glucose so much higher in the IH animals Conclusions Bullet 2 and 3 should be combined not sure you need 2 Consider getting rid of bullet before bullet 5 as it stands alone Future studies un capitalize Air??? ABSTRACT RESULTS Background: Type 2 diabetes (T2D) and obesity are highly prevalent in older adults, due to sedentary lifestyles and increasing adiposity. Obesity exacerbates the physical and metabolic impairments that occur with aging, worsening quality-of-life. However, data on the role of diabetes on physical and cognitive functions in this specific population (elderly obese) are limited. Objective: The purpose of this study was to evaluate physical and cognitive functions in elderly obese patients with T2D compared to elderly obese patients without T2D. Methods: This is a cross-sectional study of baseline measurements in 307 elderly (65-85 yrs.) obese (BMI≥30 kg/m2) adults with T2D (EO-Diabetes Group; DG) or without T2D (EO-Control Group; CG). The outcomes were physical functions (Physical Performance Test [PPT] and peak oxygen consumption [VO2peak assessed during graded treadmill]) and cognitive functions (Modified Mini-Mental State Exam [3MS], Word Fluency Test [WF], and Trail Making Test [Trails A and B].  Results: The DG (n=156) did not differ significantly from the CG (n=151) in age (70.1±3.8 vs 69.7±4.6 yrs.; p=0.42) or BMI (36.1±5.3 vs 36.3±4.6 kg/m2; p=0.74) but had higher diastolic BP (80.8±9.6 vs 75.3±11.2 mmHg, p<0.001) and by study design, higher fasting blood glucose (126.7±42.7 vs 98.0±17.1 mg/dL). The DG had lower VO2peak (16.7±3.5 vs 17.9±3.6 ml/kg/min, p=0.003) but similar PPT scores than CG (27.9±4.6 vs 28.4±2.5, p=0.20). With respect to cognitive functions, all scores were significantly lower in the DG (3MS: 92.7±11.9 vs 95.9±4.9; WF: 17.9±5 vs 19.4±5.5; Trail A 54.8±24.6 vs 43.5±20.9 sec; Trail B 119.0±61.0 vs 98.6±37.3 sec, all p value <0.05).  Conclusion: Diabetes interacts with obesity to further exacerbate physical and cognitive impairments in the obese elderly population. Intervention studies are needed to determine if lifestyle change-induced weight loss will not only improve glycemic control but also the physical and cognitive functions and quality-of-life in the elderly obese with diabetes. Characteristics of the Participants* Characteristic EO-Diabetes group (n=156) EO-Control group (n=151) p value Age, y 70.1 ± 3.8 69.7 ± 4.6 0.424 Male/female 94/62  90/61 0.908  BMI, kg/m2 36.1 ± 5.3  36.3 ± 4.6 0.743 Systolic BP, mm Hg 138.5 ± 18.5  136.2 ± 16.8 0.265 Diastolic BP, mm Hg 80.8 ± 9.6  75.3 ± 11.2 <0.001  Fasting blood glucose, mg/dL 126.7 ± 42.7 98.0 ± 17.1 *Values are means ± SD BACKGROUND The highest prevalence of diabetes is in elderly (age ≥ 65 years) adults, who constitute a rapidly expanding segment of the US population.1 This high prevalence of diabetes is strongly linked to increasing adiposity and physical inactivity with aging.2 Both aging and diabetes are not only risk factors for physical functional impairment but also both may conspire to increase the risk for cognitive impairment that predisposes to dementia, a commonly feared outcome in older patients.3 Thus, both aging and obesity can exacerbate physical and cognitive impairments, worsening overall quality of life.1,4 Few data are available on the role of diabetes in worsening physical and cognitive functions in the elderly with obesity. OBJECTIVE CONCLUSION The purpose of this study was to evaluate physical and cognitive functions in elderly (age ≥ 65 y) obese (BMI ≥ 30 kg/m2) patients with or without diabetes (i.e. EO-Diabetes group vs EO- Control group). We hypothesized that obese elderly patients with diabetes will have worse physical and cognitive functions than obese elderly patients without diabetes. Diabetes has a detrimental effect in the elderly obese population, probably due to the interaction of diabetes with obesity to further exacerbate physical and cognitive impairments. Intervention studies involving lifestyle-induced weight loss (through caloric restriction and regular exercise) are needed to determine if lifestyle change will be beneficial not only in improving glycemic control but also the physical and cognitive functions and quality-of-life in this growing population of elderly obese with type 2 diabetes. MATERIALS AND METHODS This is a cross-sectional study based on baseline measurements of obese elderly patients with and without T2D currently enrolled in several clinical trials at our research center. Physical functions were evaluated by using 1) Physical Performance Test (PPT) score and 2) peak oxygen consumption (VO2peak) assessed during graded treadmill. The PPT assesses multiple domains of physical function which predicts disability and loss of independence. Cognitive functions were evaluated by using 1) the Modified Mini-Mental State Exam (3MS), 2) Word Fluency Test (WF), and 3) Trail Making Test (Trails A and B). References 1. Sue KM et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc 2012;60:2342-2356 2. Amati F, et al. Physical inactivity and obesity underlie the insulin resistance of aging. Diabetes Care 2009;32:1547-1549 3. Villareal DT, Morris JC. The Diagnosis of Alzheimer's Disease. J Alzheimers Dis 1999;1:249-263 4. Park et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 2006;55:1813-1818