Relationships Between Daily Acute Glucose Fluctuations and Cognitive Performance Among Aged Type 2 Diabetic Patients

Objective- The mean amplitude of glycemic excursions (MAGE) is a significant determinant of overall metabolic control as well as an increased risk for diabetic complications. Older persons with type 2 diabetes mellitus (DM2) are more likely to have moderate cognitive deficits and structural changes in brain tissue. Considering that poor metabolic control is considered a deranging factor for cognitive performance in diabetics, we evaluated whether the contributions MAGE to cognitive status in DM2 older patients were independent from the main markers of glycemic control, such as sustained chronic hyperglycemia (HbA1c), post-prandial glycemia (PPG) and fasting plasma glucose (FPG). Research-Design-and-Methods- 48-h continuous subcutaneous glucose monitoring (CSGM) were assessed in 121 older DM2 patients. The MAGE and PPG were evaluated during CSGM. The relationship of MAGE to performance on cognitive tests was assessed, adjusting for age, glycemic control markers and other determinants of cognitive status. The cognitive tests were a composite score of executive and attention functioning and mini mental status examination (MMSE). Results- MAGE was significantly correlated with MMSE (r=0.83; p<0.001) and with cognition composite score (r=0.68; p<0.001). Moreover, MAGE was associated to MMSE (p<0.001) and cognition composite score (p<0.001) independently of age, sex, BMI, WHI, drug intake, physical activity, mean arterial blood pressure, FPG, PPG and HbA1c. Conclusions- The MAGE during daily period was associated with a impairment of cognitive functioning independent of HbA1c, FPG and PPG. The present data suggest that interventional trials in DM2 older patients should target not only on HbA1c PPG FPG but also on daily acute glucose swings.