by Colin Kenny, GP, Dromore
This large cohort analysis from the community-based ARIC (Atherosclerosis Risk in Communities) study was initially set up to document racial disparities in renal function over time in people with diabetes, but it has now been used to document cognitive decline in the same cohort. In all, 13,351 black and white adults aged 48–67 years at baseline (between 1990 and 1992) were included. Diabetes and pre-diabetes incidence was documented at study entry (using HbA1c), and cognitive tools were used to measure progress to dementia.
When data were analysed, two outcomes were clear: diabetes in mid-life was associated with a 19% greater cognitive decline over 20 years compared with no diabetes; and participants with poorly controlled diabetes (HbA1c level ≥53 mmol/mol [≥7.0%]) had greater decline than those whose diabetes was better controlled. In addition, the degree of cognitive decline was significantly greater among persons with pre-diabetes (HbA1c level of 39–46 mmol/mol [5.7–6.4%]) than among those with an HbA1c level less than 39 mmol/mol. There were no racial differences in cognitive decline, but longer-duration diabetes was also associated with greater late-life cognitive decline.
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