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Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study

Aims/hypothesis We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. Methods We included participants with diagnosed diabetes from th... Full description

Journal Title: Diabetologia 2018-06-30, Vol.61 (9), p.1956-1965
Main Author: Lee, Alexandra K
Other Authors: Rawlings, Andreea M , Lee, Clare J , Gross, Alden L , Huang, Elbert S , Sharrett, A. Richey , Coresh, Josef , Selvin, Elizabeth
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
ID: ISSN: 0012-186X
Link: https://www.ncbi.nlm.nih.gov/pubmed/29961106
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title: Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study
format: Article
creator:
  • Lee, Alexandra K
  • Rawlings, Andreea M
  • Lee, Clare J
  • Gross, Alden L
  • Huang, Elbert S
  • Sharrett, A. Richey
  • Coresh, Josef
  • Selvin, Elizabeth
subjects:
  • Aged
  • Apolipoprotein E
  • Apolipoproteins
  • Apolipoproteins E - genetics
  • Arteriosclerosis
  • Article
  • Atherosclerosis
  • Brain - diagnostic imaging
  • Brain - physiopathology
  • Brain volume
  • Cognition
  • Cognitive ability
  • Cognitive decline
  • Cognitive Dysfunction - complications
  • Cognitive Dysfunction - physiopathology
  • Cognitive impairment
  • Cohort Studies
  • Cross-Sectional Studies
  • Dementia
  • Dementia - complications
  • Dementia - physiopathology
  • Dementia disorders
  • Demography
  • Diabetes
  • Diabetes mellitus
  • Diabetes mellitus (non-insulin dependent)
  • Diabetes Mellitus, Type 2 - complications
  • Epidemiology
  • Female
  • Genotype
  • Genotypes
  • Human Physiology
  • Humans
  • Hypoglycaemia
  • Hypoglycemia
  • Internal Medicine
  • Magnetic Resonance Imaging
  • Male
  • Medicine
  • Medicine & Public Health
  • Metabolic Diseases
  • Middle Aged
  • Neuropsychological Tests
  • Older people
  • Organ Size
  • Risk factors
  • Survival analysis
  • Type 2 diabetes
ispartof: Diabetologia, 2018-06-30, Vol.61 (9), p.1956-1965
description: Aims/hypothesis We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. Methods We included participants with diagnosed diabetes from the community-based Atherosclerosis Risk in Communities (ARIC) study. At the participants’ fifth study visit (2011–2013), we examined the cross-sectional associations of severe hypoglycaemia with cognitive status, brain volumes and prior 15 year cognitive decline. We also conducted a prospective survival analysis of incident dementia from baseline, visit 4 (1996–1998), to 31 December 2013. Severe hypoglycaemia was identified, using ICD-9 codes, from hospitalisations, emergency department visits and ambulance records. Prior cognitive decline was defined as change in neuropsychological test scores from visit 4 (1996–1998) to visit 5 (2011–2013). At visit 5, a subset of participants underwent brain MRIs. Analyses were adjusted for demographics, APOE genotype, use of diabetes medication, duration of diabetes and glycaemic control. Results Among 2001 participants with diabetes at visit 5 (mean age 76 years), a history of severe hypoglycaemia (3.1% of participants) was associated with dementia (vs normal cognitive status): OR 2.34 (95% CI 1.04, 5.27). In the subset of participants who had undergone brain MRI ( n  = 580), hypoglycaemia was associated with smaller total brain volume (−0.308 SD, 95% CI −0.612, −0.004). Hypoglycaemia was nominally associated with a 15 year cognitive change (−0.14 SD, 95% CI −0.34, 0.06). In prospective analysis ( n  = 1263), hypoglycaemia was strongly associated with incident dementia (HR 2.54, 95% CI 1.78, 3.63). Conclusions/interpretation Our results demonstrate a strong link between severe hypoglycaemia and poor cognitive outcomes, suggesting a need for discussion of appropriate diabetes treatments for high-risk older adults.
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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titleSevere hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study
creatorLee, Alexandra K ; Rawlings, Andreea M ; Lee, Clare J ; Gross, Alden L ; Huang, Elbert S ; Sharrett, A. Richey ; Coresh, Josef ; Selvin, Elizabeth
creatorcontribLee, Alexandra K ; Rawlings, Andreea M ; Lee, Clare J ; Gross, Alden L ; Huang, Elbert S ; Sharrett, A. Richey ; Coresh, Josef ; Selvin, Elizabeth
descriptionAims/hypothesis We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. Methods We included participants with diagnosed diabetes from the community-based Atherosclerosis Risk in Communities (ARIC) study. At the participants’ fifth study visit (2011–2013), we examined the cross-sectional associations of severe hypoglycaemia with cognitive status, brain volumes and prior 15 year cognitive decline. We also conducted a prospective survival analysis of incident dementia from baseline, visit 4 (1996–1998), to 31 December 2013. Severe hypoglycaemia was identified, using ICD-9 codes, from hospitalisations, emergency department visits and ambulance records. Prior cognitive decline was defined as change in neuropsychological test scores from visit 4 (1996–1998) to visit 5 (2011–2013). At visit 5, a subset of participants underwent brain MRIs. Analyses were adjusted for demographics, APOE genotype, use of diabetes medication, duration of diabetes and glycaemic control. Results Among 2001 participants with diabetes at visit 5 (mean age 76 years), a history of severe hypoglycaemia (3.1% of participants) was associated with dementia (vs normal cognitive status): OR 2.34 (95% CI 1.04, 5.27). In the subset of participants who had undergone brain MRI ( n  = 580), hypoglycaemia was associated with smaller total brain volume (−0.308 SD, 95% CI −0.612, −0.004). Hypoglycaemia was nominally associated with a 15 year cognitive change (−0.14 SD, 95% CI −0.34, 0.06). In prospective analysis ( n  = 1263), hypoglycaemia was strongly associated with incident dementia (HR 2.54, 95% CI 1.78, 3.63). Conclusions/interpretation Our results demonstrate a strong link between severe hypoglycaemia and poor cognitive outcomes, suggesting a need for discussion of appropriate diabetes treatments for high-risk older adults.
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subjectAged ; Apolipoprotein E ; Apolipoproteins ; Apolipoproteins E - genetics ; Arteriosclerosis ; Article ; Atherosclerosis ; Brain - diagnostic imaging ; Brain - physiopathology ; Brain volume ; Cognition ; Cognitive ability ; Cognitive decline ; Cognitive Dysfunction - complications ; Cognitive Dysfunction - physiopathology ; Cognitive impairment ; Cohort Studies ; Cross-Sectional Studies ; Dementia ; Dementia - complications ; Dementia - physiopathology ; Dementia disorders ; Demography ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Epidemiology ; Female ; Genotype ; Genotypes ; Human Physiology ; Humans ; Hypoglycaemia ; Hypoglycemia ; Internal Medicine ; Magnetic Resonance Imaging ; Male ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Neuropsychological Tests ; Older people ; Organ Size ; Risk factors ; Survival analysis ; Type 2 diabetes
ispartofDiabetologia, 2018-06-30, Vol.61 (9), p.1956-1965
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1COPYRIGHT 2018 Springer
2Diabetologia is a copyright of Springer, (2018). All Rights Reserved.
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7Selvin, Elizabeth
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descriptionAims/hypothesis We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. Methods We included participants with diagnosed diabetes from the community-based Atherosclerosis Risk in Communities (ARIC) study. At the participants’ fifth study visit (2011–2013), we examined the cross-sectional associations of severe hypoglycaemia with cognitive status, brain volumes and prior 15 year cognitive decline. We also conducted a prospective survival analysis of incident dementia from baseline, visit 4 (1996–1998), to 31 December 2013. Severe hypoglycaemia was identified, using ICD-9 codes, from hospitalisations, emergency department visits and ambulance records. Prior cognitive decline was defined as change in neuropsychological test scores from visit 4 (1996–1998) to visit 5 (2011–2013). At visit 5, a subset of participants underwent brain MRIs. Analyses were adjusted for demographics, APOE genotype, use of diabetes medication, duration of diabetes and glycaemic control. Results Among 2001 participants with diabetes at visit 5 (mean age 76 years), a history of severe hypoglycaemia (3.1% of participants) was associated with dementia (vs normal cognitive status): OR 2.34 (95% CI 1.04, 5.27). In the subset of participants who had undergone brain MRI ( n  = 580), hypoglycaemia was associated with smaller total brain volume (−0.308 SD, 95% CI −0.612, −0.004). Hypoglycaemia was nominally associated with a 15 year cognitive change (−0.14 SD, 95% CI −0.34, 0.06). In prospective analysis ( n  = 1263), hypoglycaemia was strongly associated with incident dementia (HR 2.54, 95% CI 1.78, 3.63). Conclusions/interpretation Our results demonstrate a strong link between severe hypoglycaemia and poor cognitive outcomes, suggesting a need for discussion of appropriate diabetes treatments for high-risk older adults.
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10Cognition
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13Cognitive Dysfunction - complications
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15Cognitive impairment
16Cohort Studies
17Cross-Sectional Studies
18Dementia
19Dementia - complications
20Dementia - physiopathology
21Dementia disorders
22Demography
23Diabetes
24Diabetes mellitus
25Diabetes mellitus (non-insulin dependent)
26Diabetes Mellitus, Type 2 - complications
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28Female
29Genotype
30Genotypes
31Human Physiology
32Humans
33Hypoglycaemia
34Hypoglycemia
35Internal Medicine
36Magnetic Resonance Imaging
37Male
38Medicine
39Medicine & Public Health
40Metabolic Diseases
41Middle Aged
42Neuropsychological Tests
43Older people
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45Risk factors
46Survival analysis
47Type 2 diabetes
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titleSevere hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study
authorLee, Alexandra K ; Rawlings, Andreea M ; Lee, Clare J ; Gross, Alden L ; Huang, Elbert S ; Sharrett, A. Richey ; Coresh, Josef ; Selvin, Elizabeth
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0Lee, Alexandra K
1Rawlings, Andreea M
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7Selvin, Elizabeth
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jtitleDiabetologia
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date2018-06-30
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notes
0Contribution statement
1AKL conceived and designed the study, conducted statistical analyses and drafted the manuscript. AMR and ALG contributed to the statistical analyses and made critical revisions to the manuscript for important intellectual content. CJL, ESH, ARS, and JC contributed to the interpretation of data for the work and made critical revisions to the manuscript for important intellectual content. ES made contributions to the conception and design of the study and to the interpretation of data for the work, and made critical revisions to the manuscript for important intellectual content. All authors had final approval of the version to be published. ES is responsible for the integrity of the work as a whole.
abstractAims/hypothesis We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. Methods We included participants with diagnosed diabetes from the community-based Atherosclerosis Risk in Communities (ARIC) study. At the participants’ fifth study visit (2011–2013), we examined the cross-sectional associations of severe hypoglycaemia with cognitive status, brain volumes and prior 15 year cognitive decline. We also conducted a prospective survival analysis of incident dementia from baseline, visit 4 (1996–1998), to 31 December 2013. Severe hypoglycaemia was identified, using ICD-9 codes, from hospitalisations, emergency department visits and ambulance records. Prior cognitive decline was defined as change in neuropsychological test scores from visit 4 (1996–1998) to visit 5 (2011–2013). At visit 5, a subset of participants underwent brain MRIs. Analyses were adjusted for demographics, APOE genotype, use of diabetes medication, duration of diabetes and glycaemic control. Results Among 2001 participants with diabetes at visit 5 (mean age 76 years), a history of severe hypoglycaemia (3.1% of participants) was associated with dementia (vs normal cognitive status): OR 2.34 (95% CI 1.04, 5.27). In the subset of participants who had undergone brain MRI ( n  = 580), hypoglycaemia was associated with smaller total brain volume (−0.308 SD, 95% CI −0.612, −0.004). Hypoglycaemia was nominally associated with a 15 year cognitive change (−0.14 SD, 95% CI −0.34, 0.06). In prospective analysis ( n  = 1263), hypoglycaemia was strongly associated with incident dementia (HR 2.54, 95% CI 1.78, 3.63). Conclusions/interpretation Our results demonstrate a strong link between severe hypoglycaemia and poor cognitive outcomes, suggesting a need for discussion of appropriate diabetes treatments for high-risk older adults.
copBerlin/Heidelberg
pubSpringer Berlin Heidelberg
pmid29961106
doi10.1007/s00125-018-4668-1
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