Effects of Longitudinal Glucose Exposure on Cognitive and Physical Function: Results from the Action for Health in Diabetes Movement and Memory Study

• Published in: Journal of the American Geriatrics Society (JAGS) 2017-01, Vol.65 (1), p.137-145
• Main Authors: Beavers, Kristen M., Leng, Iris, Rapp, Stephen R., Miller, Michael E., Houston, Denise K., Marsh, Anthony P., Hire, Don G., Baker, Laura D., Bray, George A., Blackburn, George L., Hergenroeder, Andrea L., Jakicic, John M., Johnson, Karen C., Korytkowski, Mary T., Dorsten, Brent Van, Kritchevsky, Stephen B.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Auditory discrimination learning; Body mass index; Body weight; Cognition; Cognitive ability; Cohort Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Exercise Test; Female; Gait; Glucose; Glycated Hemoglobin A - analysis; HbA1c; Health risk assessment; Health Status; Hemoglobin; Humans; Knee; Male; Memory; Middle Aged; Neural coding; Neuropsychological Tests; Obesity - epidemiology; Overweight; Overweight - epidemiology; Physical fitness; physical function; type 2 diabetes mellitus; United States - epidemiology
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14478

Objectives To test whether average long‐term glucose exposure is associated with cognitive and physical function in middle‐aged and younger‐old adults with type 2 diabetes mellitus. Design Prospective cohort study. Setting Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Movement and Memory ancillary study (NCT01410097). Participants Overweight and obese individuals with type 2 diabetes mellitus aged 45 to 76 at baseline (N = 879). Measurements Glycosylated hemoglobin (HbA1c) was measured at regular intervals over 7 years, and objective measures of cognitive function (Trail‐Making Test, Modified Stroop Color‐Word Test, Digit Symbol‐Coding, Rey Auditory Verbal Learning Test, Modified Mini‐Mental State Examination) and physical function (Short Physical Performance Battery, expanded Physical Performance Battery, 400‐m and 20‐m gait speed) and strength (grip and knee extensor strength) were assessed at the Year 8 or 9 follow‐up examination. Results Average HbA1c exposure was 7.0 ± 1.1% (53 ± 11.6 mmol/mol), with 57% of participants classified as having HbA1c levels of less than 7% (64 mmol/mol). After adjustment for age, sex, race, education, smoking status, alcohol intake, knee pain, physical fitness, body mass index, diabetes mellitus medication and statin use, ancillary year visit, and study arm and site, higher HbA1c was associated with worse physical but not cognitive function. Further adjustment for prevalent diabetes mellitus–related comorbidities made all associations nonsignificant. Results did not differ when stratified according to participant baseline age (