Associations of hemoglobin A1c with cognition reduced for long diabetes duration

Jeremy M Silverman, James Schmeidler, Pearl G Lee, Neil B Alexander, Michal Schnaider Beeri, Elizabeth Guerrero-Berroa, Rebecca K West, Mary Sano, Martina Nabozny, Carolina Rodriguez Alvarez, Jeremy M Silverman, James Schmeidler, Pearl G Lee, Neil B Alexander, Michal Schnaider Beeri, Elizabeth Guerrero-Berroa, Rebecca K West, Mary Sano, Martina Nabozny, Carolina Rodriguez Alvarez

Abstract

Introduction: Associations of some risk factors with poor cognition, identified prior to age 75, are reduced or reversed in very old age. The Protected Survivor Model predicts this interaction due to enhanced survival of those with extended risk factor duration. In a younger sample, this study examines the association of cognition with the mean hemoglobin A1c risk factor over the time at risk, according to its duration.

Methods: The interaction of mean hemoglobin A1c (average = 9.8%), evaluated over duration (average = 116.8 months), was examined for overall cognition and three cognitive domains in a sample of 150 "young-old" veterans (mean age = 70) with type 2 diabetes.

Results: The predicted interactions were significant for overall cognition and attention, but not executive functions/language and memory.

Discussion: Findings extend the Protected Survivor Model to a "young-old" sample, from the very old. This model suggests focusing on individuals with good cognition despite prolonged high risk when seeking protective factors.

Keywords: Cognitive function; Diabetes duration; Hemoglobin A1c; Protected survivor; Protective factors; Risk factors; Type 2 diabetes.

Figures

Fig. 1
Fig. 1
HbA1c by overall cognition scores divided by duration groups. Mean HbA1c by overall cognition scores in veterans with T2D dichotomized at the low end of the upper third (157.72 months), creating a long T2D duration group (157.74–215.15 months; upper panel) and shorter T2D duration group (7.41–157.70 months; lower panel). In each plot, the dashed vertical line from the x-axis is the dichotomization cut point at the low end of the upper third for HbA1c (10.535%). Solid line in each panel is the regression line for all participants in the T2D duration group. Dotted lines in each panel are the regression lines for participants in the lower and high HbA1c subgroups. For each subgroup, means and standard deviations of HbA1c and overall cognition scores are black stars with vertical bars. Abbreviations: HbA1c, hemoglobin A1c; T2D, type 2 diabetes.

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