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. 2018 Apr;61(4):839-848.
doi: 10.1007/s00125-017-4541-7. Epub 2018 Jan 25.

HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing

Fanfan Zheng  1   2 , Li Yan  3 , Zhenchun Yang  3 , Baoliang Zhong  4 , Wuxiang Xie  5   6
Affiliations

HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing

Fanfan Zheng et al. Diabetologia. 2018 Apr.

Abstract

Aims/hypothesis: The aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period.

Methods: Data from wave 2 (2004-2005) to wave 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA) were analysed. Cognitive function was assessed at baseline (wave 2) and reassessed every 2 years at waves 3-7. Linear mixed models were used to evaluate longitudinal associations.

Results: The study comprised 5189 participants (55.1% women, mean age 65.6 ± 9.4 years) with baseline HbA1c levels ranging from 15.9 to 126.3 mmol/mol (3.6-13.7%). The mean follow-up duration was 8.1 ± 2.8 years and the mean number of cognitive assessments was 4.9 ± 1.5. A 1 mmol/mol increment in HbA1c was significantly associated with an increased rate of decline in global cognitive z scores (-0.0009 SD/year, 95% CI -0.0014, -0.0003), memory z scores (-0.0005 SD/year, 95% CI -0.0009, -0.0001) and executive function z scores (-0.0008 SD/year, 95% CI -0.0013, -0.0004) after adjustment for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity C-reactive protein, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer. Compared with participants with normoglycaemia, the multivariable-adjusted rate of global cognitive decline associated with prediabetes and diabetes was increased by -0.012 SD/year (95% CI -0.022, -0.002) and -0.031 SD/year (95% CI -0.046, -0.015), respectively (p for trend <0.001). Similarly, memory, executive function and orientation z scores showed an increased rate of cognitive decline with diabetes.

Conclusions/interpretation: Significant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline were observed in this study. Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes.

Keywords: Cognitive decline; Diabetes; HbA1c; Trajectory.

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Conflict of interest statement

The authors declare that there is no duality of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1
Flow chart of participant selection for the present study population
Fig. 2
Fig. 2
Trajectories of cognitive z scores by baseline diabetes status (solid lines, normal; dotted lines, prediabetes; dashed lines, diabetes), adjusted for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity CRP, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer
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