1. Does intensive glucose control prevent cognitive decline in diabetes
Does intensive glucose control prevent cognitive decline in diabetes? A meta-analysis Carlos Peñaherrera-Oviedo M.D.1; Daniel Moreno M.D.1; María Carolina Duarte M.S.1; Michael Palacios M.S.1; María Beatriz Jurado Ph.D.1; Rocío Santibañez M.D.1; Leonardo Tamariz M.D., M.P.H.2 1 Universidad Católica de Santiago de Guayaquil, Facultad de Ciencias Médicas; 2 Miller School of Medicine, University of Miami
Discussion
Results varied from type 1 to type 2 diabetics.
Lack of benefit in type 1 DM may derive from younger age and no other comorbidities.
Intensive glucose control in type 2 diabetics improved performance in processing speed and executive function, but worsened it for memory and attention, probably because of higher age and the presence of comorbidities that may also affect cognitive function.
There are not enough strong comparable studies of cognitive function in type 2 diabetics subjected to intensive glucose control.
One DM2 study reported higher mortality on the intensive group.
Background
Diabetes mellitus (DM) is associated with progressive cognitive decline.
The impact of intensive glucose control in cognitive function is not well-established.
Table 1: Baseline Characteristics of the 7 included RCCTs
Figure 2: SMDs for cognitive function tests in diabetes
Specific aims
We performed a meta-analysis to evaluate if intensive glucose control could prevent the onset of cognitive decline.
Materials and methods
We searched the MEDLINE database using PubMed, for articles from 1980 to 2014.
Keywords: “type 1 diabetes mellitus”, “type 2 diabetes mellitus”, “drug therapy”, and “cognitive function”
Inclusion criteria: RCCTs, intensive therapy group vs. conventional group, with cognitive function outcomes.
Exclusion criteria: established dementia, used only MMSE, cognitive tests not comparable.
“Intensive glucose control” generally defined as attaining normal HbA1c levels.
We calculated standardized mean difference (SMD) for each cognitive test after follow-up.
Neurocognitive tests included and cognitive domain evaluated
Digit Symbol Substitution test (DSST) for information-processing speed.
Trail Making Test B (TMT), for executive function.
Similarities subtest of the WAIS, for executive function.
Rey Auditory Verbal Learning Test (RAVLT), for memory.
Stroop color test, for attention.
Finger Tapping Test in both hands, for motor function.
Table 2: Mean (SD) results from each cognitive function test used
Conclusions
Intensive glucose control has no cognitive benefit for type 1 diabetics.
In type 2 DM, it seems to benefit processing speed and executive function while worsening memory and attention, however, more studies are required.
When using tight glucose control, risk of higher mortality should be addressed.
Figure 1: PubMed Search and Results
Disclosures: Carlos Peñaherrera-Oviedo, MD – None / Daniel Moreno, MD – None / María Carolina Duarte, MS – None / Michael Palacios, MS – None / María Beatriz Jurado, PhD – None / Rocío Santibañez, MD - None / Leonardo Tamariz, MD – None