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17-10-2010 | Diabetes | Article

Acute fluctuations in glucose decrease cognitive ability of Type 2 diabetics


Free abstract

MedWire News: Major fluctuations in glucose levels in older adults with Type 2 diabetes are linked to decreased cognitive ability, show results published in the journal Diabetes Care.

Raffaele Marfella (Second University of Naples, Italy) and colleagues measured the mean amplitude of glycemic excursions (MAGE) and postprandial glycemia (PPG) over a period of 48 hours in 121 older patients (mean age 78 years) with Type 2 diabetes.

The team assessed links between performance in various cognitive tests - composite score from executive and attention functioning tests and the Mini Mental Status Examination (MMSE) - and MAGE.

The researchers found that MAGE was significantly correlated with MMSE and the cognition composite score, in that both scores decreased with increasing MAGE.

For example, participants with a MMSE score of 28 had MAGE ranging from 22-58 mg/dl, whereas those with a score of 24 had MAGE ranging from 87-100 mg/dl.

Further analysis showed these associations to be significant even after adjustment for age, gender, body mass index, waist-to-hip ratio, drug intake, blood pressure, physical activity, fasting glucose, PPG, and glycated hemoglobin (HbA1c) level.

"It is widely known that older individuals with Type 2 diabetes are more likely to experience cognitive decline than those without Type 2 diabetes," say Marfella and co-workers.

"Our study shows that impairment of cognitive performance in older Type 2 diabetic patients may be associated with daily acute glucose fluctuations."

The researchers concede that a weakness of this study is its observational and cross-sectional nature making it impossible to assume a causal relationship.

But they say that as glycemic disorders such as Type 2 diabetes are linked with both mild and major cognitive disorders such as vascular dementia and Alzheimer's disease, "the present data open the field for conducting interventional studies with the aim of treating glycemic disorders not only by reducing HbA1c and mean hyperglycemia but also by flattening acute glucose fluctuations."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert