Clinical

Daily glucose swings tied to cognitive impairment in elderly diabetics

NEW YORK (Reuters Health) - Independent of the usual markers of glycemic control, the amplitude of daily glucose excursions is linked with cognitive function in elderly type 2 diabetics, Italian researchers have shown.

As reported online June 23rd in Diabetes Care, Dr. Raffaele Marfella and colleagues at the Second University of Naples studied 121 outpatients with type 2 diabetes ranging in age from 65 to 88 years.

None of the subjects had carotid plaque >70% on ultrasound examination, or white matter lesions or significant cortical or subcortical atrophy on MRI scans.

Using data from continuous subcutaneous glucose monitoring, the investigators found that the mean amplitude of glycemic excursion (MAGE) over 24 hours was 71 mg/dL, while the mean 24-hour glucose level was 176 mg/dL.

One to two days before continuous glucose monitoring began, the subjects all underwent extensive assessments of their cognitive function.

MAGE was significantly correlated with Mini Mental Status Examination scores (r = 0.83, p<0.001) and with a cognition composite score (r= 0.68, p<0.001) that included executive and attention functioning, Dr. Marfella and colleagues report.

Furthermore, the relationship between MAGE and cognitive function was independent of HbA1c, postprandial glucose levels and fasting plasma glucose readings.

"The rapid glucose swings from relatively high glucose levels during postprandial periods to low values or even to asymptomatic hypoglycemia, and its associated neuroglycopenia, may largely contribute to a more rapid decline of metabolic activity in the brain," the researchers suggest.

Dr. Marfella told that the next step, based on the findings, seems clear. "The present data open the field to conduct interventional studies aimed at treating glycemic disorders not only by reducing HbA1c and mean hyperglycemia but also by flattening acute glucose fluctuations."

He advised, "The best way to prevent swings in glucose levels is to set hypoglycemic therapy not only for the prandial period but also for interprandial period."

Diabetes Care 2010.

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