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Cited by 447Dementia and Cognitive Impairment ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

Diabetes in Midlife and Cognitive Change Over 20 Years: A Cohort Study

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Rawlings, Andreea M., Sharrett, A. Richey, Schneider, Andrea L.C., Coresh, Josef, Albert, Marilyn, Couper, David, Griswold, Michael, Gottesman, Rebecca F. +3 more·2014·Annals of Internal Medicine
DOI 10.7326/m14-0737PMC PMC4432464
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Abstract

BACKGROUND: Type 2 diabetes is associated with dementia risk, but evidence is limited for possible associations of diabetes and prediabetes with cognitive decline. OBJECTIVE: To determine whether diabetes in midlife is associated with 20-year cognitive decline and to characterize long-term cognitive decline across clinical categories of hemoglobin A1c (HbA1c) levels. DESIGN: Prospective cohort study. SETTING: The community-based ARIC (Atherosclerosis Risk in Communities) study. PARTICIPANTS: 13,351 black and white adults aged 48 to 67 years at baseline (1990 to 1992). MEASUREMENTS: Diabetes was defined by self-reported physician diagnosis or medication use or HbA1c level of 6.5% or greater. Undiagnosed diabetes, prediabetes, and glucose control in persons with diagnosed diabetes were defined by clinical categories of HbA1c level. Delayed word recall, digit symbol substitution, and word fluency tests were used to assess cognitive performance and were summarized with a global Z score. RESULTS: Diabetes in midlife was associated with a 19% greater cognitive decline over 20 years (adjusted global Z-score difference, -0.15 [;95% CI, -0.22 to -0.08];) compared with no diabetes. Cognitive decline was significantly greater among persons with prediabetes (HbA1c level of 5.7% to 6.4%) than among those with an HbA1c level less than 5.7%. Participants with poorly controlled diabetes (HbA1c level ≥ 7.0%) had greater decline than those whose diabetes was controlled (adjusted global Z-score difference, -0.16; P = 0.071). Longer-duration diabetes was also associated with greater late-life cognitive decline (P for trend < 0.001). Rates of decline did not differ significantly between white and black persons (P for interaction = 0.44). LIMITATION: Single HbA1c measurement at baseline, 1 test per cognitive domain, and potential geographic confounding of race comparisons. CONCLUSION: Diabetes prevention and glucose control in midlife may protect against late-life cognitive decline. PRIMARY FUNDING SOURCE: National Institutes of Health.

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  • Longer duration of diabetes is associated with worsening cognitive function.

    “Poor glycemic management is associated with a decline in cognitive function (15,16), and longer duration of diabetes is associated with worsening cognitive function.”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [16]

  • Poor glycemic management is associated with a decline in cognitive function.

    “Poor glycemic management is associated with a decline in cognitive function (15,16), and longer duration of diabetes is associated with worsening cognitive function.”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [16]

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Authors
Rawlings, A. M., Sharrett, A. R., Schneider, A. L. C., Coresh, J., Albert, M., Couper, D., Griswold, M., Gottesman, R. F., Wagenknecht, L. E., Windham, B. G., & Selvin, E.
Affiliations
University of North Carolina at Chapel Hill (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2014-12-02
Volume
161
Issue
11
Pages
785-793
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m14-0737
PMC
PMC4432464
OpenAlex
W2015202736
Cited by
447
References
7
Citations by year
2026: 26 · 2025: 40 · 2024: 36 · 2023: 42 · 2022: 48 · 2021: 53 · 2020: 29 · 2019: 40 · 2018: 29 · 2017: 41 · 2016: 30 · 2015: 31 · 2014: 2
FWCI
26.47
Type
journal article
Language
en
Open access
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5u01hl096899-08, 5u01hl096902-08)
  • U.S. Public Health Service (HHSN268201100012C), HHSN2682 01100010C, HHSN268201100007 C, HHSN2682011-00008C, HHSN268201100 006C, HHSN2682‐01100011C, HHSN268201100009C, HHSN 268201100005C)
  • National Institute on Aging (R01AG040282)
  • National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, R01 HL70825, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, HL096814, HHSN2682011-­00009I, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HHSN268201100011I, U01HL096814, U01-HL-096899, HL-096902, HHSN26820 1100009C, U01-HL-096902, HHSN2682011-00008I, HL-096899, U01HL096917, HL-096917, R01HL070825, T32HL007024, U01HL096812)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK089174)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 2 diabetes, prediabetes, cognitive decline, midlife, HbA1c, glycemic control, diabetes duration, dementia risk, delayed word recall, verbal fluency, Atherosclerosis Risk in Communities Study
MeSH terms
Aged, Black or African American, Cognition Disorders, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, White People, Propensity Score

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