title: Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study.
abstract: To determine the association of verbal intelligence, a core constituent of health literacy, with diabetic complications and walking speed in people with Type 2 diabetes.
  
  
  
  This study was performed in 228 people with Type 2 diabetes participating in the Maastricht Study, a population-based cohort study. We examined the cross-sectional associations of score on the vocabulary test of the Groningen Intelligence Test with: 1) determinants of diabetic complications (HbA1c, blood pressure and lipid level); 2) diabetic complications: chronic kidney disease, neuropathic pain, self-reported history of cardiovascular disease and carotid intima-media thickness; and 3) walking speed. Analyses were performed using linear regression and adjusted in separate models for potential confounders and mediators. Significant age- and sex-adjusted associations were additionally adjusted for educational level in a separate model.
  
  
  
  After full adjustment, lower verbal intelligence was associated with the presence of neuropathic pain [odds ratio (OR) 1.18, 95% CI 1.02;1.36], cardiovascular disease (OR 1.14, 95% CI 1.01;1.30), and slower walking speed (regression coefficient -0.011 m/s, 95% CI -0.021; -0.002 m/s). These associations were largely explained by education. Verbal intelligence was not associated with blood pressure, glycaemic control, lipid control, chronic kidney disease or carotid intima-media thickness.
  
  
  
  Lower verbal intelligence was associated with the presence of some diabetic complications and with a slower walking speed, a measure of physical functioning. Educational level largely explained these associations. This implies that clinicians should be aware of the educational level of people with diabetes and should provide information at a level of complexity tailored to the patient.
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.|School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: P J J
authors.initials: PJ
authors.lastname: Spauwen
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.|School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: R J H
authors.initials: RJ
authors.lastname: Martens
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.|School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: F R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Schram
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: S J S
authors.initials: SJ
authors.lastname: Sep
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: C J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.|School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: R M A
authors.initials: RM
authors.lastname: Henry
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.|School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: M P J
authors.initials: MP
authors.lastname: van Boxtel
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000378:metabolism; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D057220:Health Literacy; D006801:Humans; D007360:Intelligence / Q000502:physiology*; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014825:Vocabulary; D000072797:Walking Speed / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL