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Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics

From the Department of Geriatric Medicine and Metabolic Diseases (A.M.A., M.R.R., M.B., R.G., A.A., M.T.L., N.P., F.C., G.P.), Second University of Naples, and Antidiabetic Center "Lepanto" (R.A.), Naples, Italy.

Address correspondence and reprint requests to Dr. G. Paolisso, Department of Geriatric Medicine and Metabolic Diseases, VI Divisione di Medicina Interna, Piazza Miraglia 2, I-80138 Napoli, Italy; e-mail: giuseppe.paolisso{at}unina2.it

Background: Postprandial plasma glucose (PPG) excursion 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 neurophysiologic and structural changes in brain tissue. Considering that poor metabolic control is considered a deranging factor for tissue/organ damage in diabetics, the authors hypothesized that PPG excursion is associated with a decline in cognitive functioning and that a tighter control of PPG may prevent cognitive decline.

Methods: Two groups of aged diabetic patients were randomly selected to be treated with repaglinide (n = 77) or glibenclamide (n = 79).

Results: Coefficient of variation of PPG (CV-PPG) was associated with Mini-Mental State Examination (MMSE) scores (r = –0.3410; p < 0.001) and a composite score of executive and attention functioning (r = –0.3744; p < 0.001) after adjusting for multiple confounders. Both groups showed a significant decline in hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), but only the repaglinide group demonstrated a significant decline of CV-PPG over time. In models investigating the change in cognitive functioning over time, adjusted for HbA1c and CV-FPG, a decline in cognitive functioning was observed only in the glibenclamide group (p < 0.001). After adjusting for CV-PPG, the authors no longer found a decline in executive and attention functioning composite score (p = 0.085) or the MMSE (p = 0.080) with glibenclamide.

Conclusions: Exaggerated postprandial glucose (PPG) excursions are associated with a derangement of both global, executive, and attention functioning. A tighter control of PPG may prevent cognitive decline in older diabetic individuals.

Funded by the Second University of Naples (fiscal year 2004).

Disclosure: The authors report no conflicts of interest.

Received May 31, 2005. Accepted in final form March 22, 2006.

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