title: Glycemic control, inflammation, and cognitive function in older patients with type 2 diabetes.
abstract: OBJECTIVE
  Glycated hemoglobin (HbA1c) and C-reactive protein (CRP) have been associated with cognitive impairment independently. However, it is unclear if their combination exacerbates poor cognitive function. We assessed whether long-term glycemic level and glycemic variability modulate the association of systemic inflammation with cognitive function, in a sample of cognitively normal older people with type 2 diabetes.
  
  
  METHODS
  A retrospective cohort study of 777 randomly selected participants from ~11,000 patients in the Maccabi Healthcare Services Diabetes Registry, as part of the Israel Diabetes and Cognitive Decline study. Subjects averaged 18 (±9.4) HbA1c measures in the Maccabi Healthcare Services Registry, which were used to calculate long-term glycemic level (HbA1c-mean) and glycemic variability (HbA1c-standard deviation (SD)). Linear regression models assessed the interactions of CRP, a marker of systemic inflammation, with HbA1c-mean and HbA1c-SD on subjects' performance in tests of Memory, Executive Functions, Attention, and Semantic Categorization.
  
  
  RESULTS
  Quadratic interactions of CRP with HbA1c-SD approached significance for executive functions and overall cognition. However, after Bonferroni adjustment, none of the interactions of CRP with HbA1c were statistically significant. In partial correlations according to HbA1c-SD tertiles, CRP was weakly correlated in the middle tertile with decreased performance in the domains of semantic categorization (r = -0.166, p = 0.011), executive functions (r = -0.136, p = 0.038), and overall cognition (r = -0.157, p = 0.016).
  
  
  CONCLUSIONS
  Glycated hemoglobin does not substantially modulate the association of CRP with cognition in a sample of cognitively normal, community dwelling older people with relatively well-managed type 2 diabetes.
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Akrivos
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Ramit
authors.initials: R
authors.lastname: Ravona-Springer
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Schmeidler
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Rambam Medical Center, Haifa, Israel.
authors.forename: Derek
authors.initials: D
authors.lastname: LeRoith
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Anthony
authors.initials: A
authors.lastname: Heymann
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Preiss
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Hoffman
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Koifman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Silverman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel.|Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Schnaider Beeri
mesh_terms: D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000502:physiology*; D002097:C-Reactive Protein / Q000032:analysis; D003071:Cognition / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000503:physiopathology*; D007557:Israel; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin
keywords: C-reactive protein; HbA1c; cognitive function; older people; type 2 diabetes