title: Trajectories in glycemic control over time are associated with cognitive performance in elderly subjects with type 2 diabetes.
abstract: OBJECTIVE
  To study the relationships of long-term trajectories of glycemic control with cognitive performance in cognitively normal elderly with type 2 diabetes (T2D).
  
  
  METHODS
  Subjects (n = 835) pertain to a diabetes registry (DR) established in 1998 with an average of 18 HbA1c measurements per subject, permitting identification of distinctive trajectory groups of HbA1c and examining their association with cognitive function in five domains: episodic memory, semantic categorization, attention/working memory, executive function, and overall cognition. Analyses of covariance compared cognitive function among the trajectory groups adjusting for sociodemographic, cardiovascular, diabetes-related covariates and depression.
  
  
  RESULTS
  Subjects averaged 72.8 years of age. Six trajectories of HbA1c were identified, characterized by HbA1c level at entry into the DR (Higher/Lower), and trend over time (Stable/Decreasing/Increasing). Both groups with a trajectory of decreasing HbA1c levels had high HbA1c levels at entry into the DR (9.2%, 10.7%), and high, though decreasing, HbA1c levels over time. They had the worst cognitive performance, particularly in overall cognition (p<0.02) and semantic categorization (p<0.01), followed by that of subjects whose HbA1c at entry into the DR was relatively high (7.2%, 7.8%) and increased over time. Subjects with stable HbA1c over time had the lowest HbA1c levels at entry (6.0%, 6.8%) and performed best in cognitive tests.
  
  
  CONCLUSIONS
  Glycemic control trajectories, which better reflect chronicity of T2D than a single HbA1c measurement, predict cognitive performance. A trajectory of stable HbA1c levels over time is associated with better cognitive function.
authors.affiliation: Memory clinic, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Ramit
authors.initials: R
authors.lastname: Ravona-Springer
authors.affiliation: Department of Family Medicine, University of Tel Aviv, Tel Aviv, Israel.
authors.forename: Anthony
authors.initials: A
authors.lastname: Heymann
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Schmeidler
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: Mary
authors.initials: M
authors.lastname: Sano
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: Derek
authors.initials: D
authors.lastname: Leroith
authors.affiliation: Geriatric Research Education and Clinical Center, Madison VA Hospital and Alzheimer's Disease Research Center, Department of Medicine, University of Wisconsin, WI, United States of America.
authors.forename: Sterling
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Maccabi Health Services, Tel Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Preiss
authors.affiliation: Memory clinic, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Koifman
authors.affiliation: Maccabi Health Services, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Hoffman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Silverman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Michal Schnaider
authors.initials: MS
authors.lastname: Beeri
mesh_terms: D000368:Aged; D003071:Cognition; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007557:Israel; D008297:Male; D012042:Registries; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin