title: Improved diabetes control in the elderly delays global cognitive decline.
abstract: OBJECTIVE
  To examine whether improved diabetes control is related to better cognitive outcomes.
  
  
  METHODS
  Randomized control trial.
  
  
  METHODS
  A randomized trial of telemedicine vs. usual care in elderly persons with type 2 diabetes.
  
  
  METHODS
  Participants were 2169 persons 55 years and older with type 2 diabetes from New York City and Upstate New York.
  
  
  METHODS
  The diabetes case management intervention was implemented by a diabetes nurse, via a telemedicine unit in the participant's home, and in coordination with the primary care physician.
  
  
  METHODS
  Hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL), were measured at a baseline visit and at up to 5 annual follow-up visits. Global cognition was measured at those visits with the Comprehensive Assessment and Referral Evaluation (CARE).
  
  
  RESULTS
  In mixed models the intervention was related to slower global cognitive decline in the intervention group (p = 0.01). Improvements in HbA1c (p = 0.03), but not SBP or LDL, mediated the effect of the intervention on cognitive decline.
  
  
  CONCLUSIONS
  Improved diabetes control in the elderly following existing guidelines through a telemedicine intervention was associated with less global cognitive decline. The main mediator of this effect seemed to be improvements in HbA1c.
authors.affiliation: Department of Medicine, Columbia University, Division of General Medicine, PH9East-105, 630 West 168th street, New York, NY 10032, USA. jal94@columbia.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Luchsinger
authors.forename: W
authors.initials: W
authors.lastname: Palmas
authors.forename: J A
authors.initials: JA
authors.lastname: Teresi
authors.forename: S
authors.initials: S
authors.lastname: Silver
authors.forename: J
authors.initials: J
authors.lastname: Kong
authors.forename: J P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: R S
authors.initials: RS
authors.lastname: Weinstock
authors.forename: S
authors.initials: S
authors.lastname: Shea
mesh_terms: D000368:Aged; D001794:Blood Pressure; D019090:Case Management; D008078:Cholesterol, LDL / Q000097:blood; D003072:Cognition Disorders / Q000097:blood / Q000517:prevention & control*; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000451:nursing*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods*
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin