Association of Glycemia, Lipids, and Blood Pressure With Cognitive Performance in People With Type 2 Diabetes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

• Published in: Diabetes care Vol. 44; no. 10; pp. 2286 - 2292
• Main Authors: Luchsinger, José A, Younes, Naji, Manly, Jennifer J, Barzilay, Joshua, Valencia, Willy, Larkin, Mary E, Falck-Ytter, Corinna, Krause-Steinrauf, Heidi, Pop-Busui, Rodica, Florez, Hermes, Seaquist, Elizabeth
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-10-2021
• Subjects: Aged; Blood glucose; Blood Pressure; Cognition; Cognition & reasoning; Cognitive ability; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Effectiveness studies; Epidemiology/Health Services Research; Executive function; Female; Health risks; Hemoglobin; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Lipids; Low density lipoprotein; Middle Aged; Reduction; Research design; Risk analysis; Risk factors
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc20-2858

Type 2 diabetes is a risk factor for cognitive impairment. We examined the relation of glycemia, lipids, blood pressure (BP), hypertension history, and statin use with cognition in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).
Cross-sectional analyses from GRADE at baseline examined the association of glycemia (hemoglobin A
[HbA
]), LDL, systolic BP (SBP) and diastolic BP (DBP), hypertension history, and statin use with cognition assessed by the Spanish English Verbal Learning Test, letter and animal fluency tests, and Digit Symbol Substitution Test (DSST).
Among 5,047 GRADE participants, 5,018 (99.4%) completed cognitive assessments. Their mean age was 56.7 ± 10.0 years, and 36.4% were women. Mean diabetes duration was 4.0 ± 2.7 years. HbA
was not related to cognition. Higher LDL was related to modestly worse DSST scores, whereas statin use was related to modestly better DSST scores. SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg were related to modestly better DSST scores. Hypertension history was not related to cognition.
In people with type 2 diabetes of a mean duration of <5 years, lower LDL and statin use were related to modestly better executive cognitive function. SBP levels in the range of 120-139 mmHg and DBP levels in the range of 80-89 mmHg, but not lower levels, were related to modestly better executive function. These differences may not be clinically significant.