Factors associated with poor glycaemic control in type 2 diabetic elderly patients with mild cognitive impairment
More details
Hide details
Department of Propaedeutics of Lifestyle Diseases Medical University of Lodz, Poland
Department of General and Oncological Pneumology Medical University of Lodz, Poland
Corresponding author
Malgorzata Gorska-Ciebiada   

Department of Propaedeutics of Lifestyle Diseases Medical University of Lodz, 63 Jaracza Street, 90-251, Lodz, Poland
J Pre Clin Clin Res. 2019;13(4):143-149
Introduction and objective.:
Recently, data has indicated a higher incidence of mild cognitive impairment (MCI) in patients with diabetes. Old age is a risk factor for cognitive deterioration and dementia. The aim of the study was to find the factors associated with poor glycaemic control in type 2 diabetic elderly patients with MCI.

Material and methods:
A cross-sectional study was conducted on 87 diabetic patients with MCI in an outpatient clinic. All subjects were screened for MCI using the Montreal Cognitive Assessment (MoCA). Detailed medical history and collection of blood test samples were performed.

83.9% of participants had poor glycaemic control. A positive correlation was found between HbA1c level and number of visit to a doctor per year, number of co-morbidities, duration of T2DM, triglycerides and fasting glucose level; and a negative correlation between HbA1c level and years of education, HDL cholesterol level and MoCA score. The univariate logistic regression models revealed factors which are associated with poor glycemic control are: less years of education, higher no of visit to doctor per year, increased number of co-morbidities, presence of CVD, retinopathy, higher levels of triglycerides and fasting glucose, lower level of HDL cholesterol, lower MoCA score. Multivariable model revealed that higher plasma levels of fasting glucose and triglycerides are significant predictors.

There is a high prevalence of poor glycemic control patients among elderly diabetics with MCI. Higher plasma levels of fasting glucose and triglycerides seems to be the most important predictors of poor glycemic control, however father larger studies are needed to elucidate these relationships.

Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, et. al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017; 128: 40–50.
Xue M, Xu W, Ou YN, Cao XP, Tan MS, Tan L, et al. Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies. Ageing Res Rev. 2019; 55: 100944.
Black S, Kraemer K, Shah A, Simpson G, Scogin F, Smith A. Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation.Curr Diab Rep. 2018; 18: 118. https://doi. org/10.1007/s11892-018-1079-0.
Petersen RC, Roberts RO, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, et al. Mild cognitive impairment: ten years later. Arch Neurol. 2009; 66: 1447–1455.
Hermida AP, McDonald WM, Steenland K, Levey AT. The association between late-life depression, mild cognitive impairment and dementia: is inflammation the missing link? Expert Rev Neurother. 2012; 12: 1339–1350.
Gorska-Ciebiada M, Saryusz-Wolska M, Borkowska A, Ciebiada M, Loba J. Serum levels of inflammatory markers in depressed elderly patients with diabetes and mild cognitive impairment. PLoS ONE 2015; 10(3): e0120433.
Hosny SS, Bahaaeldin AM, Khater MS, Bekhet MM, Hebah HA, Hasanin GA. Role of Inflammatory Markers in Elderly Type 2 Diabetic Patients with Mild Cognitive Impairment.Curr Diabetes Rev. 2019; 15: 247–253.
Serlin Y, Levy J, Shalev H. Vascular pathology and blood-brain barrier disruption in cognitive and psychiatric complications of type 2 diabetes mellitus. Cardiovasc Psychiatry Neurol. 2011; 2011: 609202. https://doi. org/10.1155/2011/609202.
Xu W, Qiu C, Gatz M, Pedersen NL, Johansson B, Fratiglioni L. Mid- and late-life diabetes in relation to the risk of dementia: a population-based twin study. Diabetes. 2009; 58(1): 71–77.
Messier C. Impact of impaired glucose tolerance and type 2 diabetes on cognitive aging. Neurobiol Aging. 2005; 26(Suppl 1): 26–30.
de Wet H, Levitt N, Tipping B. Executive cognitive impairment detected by simple bedside testing is associated with poor glycaemic control in type 2 diabetes. S Afr Med J. 2007; 97(11): 1074–1076.
Munshi M, Grande L, Hayes M, et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006; 29(8): 1794–1799.
Gorska-Ciebiada M, Saryusz-Wolska M, Ciebiada M, Loba J. Mild cognitive impairment and depressive symptoms in elderly patients with diabetes – prevalence, risk factors and co-morbidity. J Diabetes Res. 2014; 179648.
Nasreddine ZS, Phillips NA, B´edirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53: 695–699.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970; 10: 20–30.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 3: 179–86.
Alagiakrishnan K, Zhao N, Mereu L, Senior P, Senthilselvan A. Montreal Cognitive Assessment is superior to standardized Mini-Mental Status Exam in detecting Mild Cognitive Impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. Biomed Res Int. 2013; 2013: 186106.
Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004; 256: 183–194.
Portet F, Ousset PJ, Visser PJ, Frisoni GB, Nobili F, Scheltens P, et al. Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry 2006; 77: 714–778.
American Diabetes Association. Standards of medical care in diabetes 2014. Diabetes Care 2014; 37: S14–80.
Strachan MW. D Lawrence Lecture 2010. The brain as a target organ in Type 2 diabetes: exploring the links with cognitive impairment and dementia. Diabet Med. 2011; 28: 141–147. 5491.2010.03199.x.
Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, et al. The Association of Late-Life Diabetes Status and Hyperglycemia With Incident Mild Cognitive Impairment and Dementia: The ARIC Study. Diabetes Care. 2019; 42: 1248–1254. https://
Umegaki H, Hayashi T, Nomura H, Yanagawa M, Nonogaki Z, Nakshima H, et al. Cognitive dysfunction: An emerging concept of a new diabetic complication in the elderly Geriatr Gerontol Int 2013; 13: 28–34. https://
Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors. The Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial. Diabetes Care 2009; 32: 221–226.
Umegaki H, Kawamura T, Mogi N, Umemura T, Kanai A, Sano T. Glucose control levels, ischaemic brain lesions, and hyperinsulinaemia were associated with cognitive dysfunction in diabetic elderly. Age Ageing 2008;37:458–461.
Yaffe K, Blackwell T, Whitmer RA, Krueger K, Barrett Connor E. Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women. J Nutr Health Aging 2006; 10: 293–295.
Imamine R, Kawamura T, Umemura T, Umegaki H, Kawano N, Hotta M, et al. Does cerebral small vessel disease predict future decline of cognitive function in elderly patients with type 2 diabetes? Diabetes Res Clin Pract. 2011; 94: 91–99.
Grober E, Hall CB, Hahn SR, Lipton RB. Memory Impairment andn Executive Dysfunction are Associated with Inadequately Controlled Diabetes in Older Adults. J Prim Care Community Health 2011; 2: 229–233.
Reijmer YD, van den Berg E, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev 2010; 27: 195–202.
Ding J, Strachan MW, Reynolds RM, Frier BM, Deary IJ, Fowkes FG, et al. Diabetic retinopathy and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes 2010; 59: 2883–2889.
Dray-Spira R, Gary TL, Brancati FL. Socioeconomic position and cardio-vascular disease in adults with and without diabetes: United States trends,1997–2005. J Gen Intern Med. 2008; 23: 1634–1641. Singh S, Zieman S, Go AS, Fortmann SP, Wenger NK, Fleg JL, et al.
Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making. J Am Geriatr Soc. 2018; 66: 2188– 2196. 10.1111/jgs.15449.
Shorr RI, de Rekeneire N, Resnick HE, Yaffe K, Somes GW, Kanaya AM, et al. Simonsick EM. Glycemia and cognitive function in older adults using glucose-lowering drugs. J Nutr Health Aging 2006; 10: 297–301.
Crane PK, Walker R, Hubbard RA et al. Glucose levels and risk of dementia. N Engl J Med. 2013; 369: 540–548.
Kerti L, Witte AV, Winkler A et al. Higher glucose levels associated with lower memory and reduced hippocampal microstructure. Neurology 2013; 81: 1746–1752.
Raffaitin C, Gin H, Empana JP, Helmer C, Berr C, Tzourio C, et al. Metabolic syndrome and risk for incident Alzheimer’s disease or vascular dementia: the Three-City Study. Diabetes Care 2009; 32: 169–174.
Rouch I, Trombert B, Kossowsky MP, Laurent B, Celle S, Ntougou Assoumou G, et al. Metabolic syndrome is associated with poor memory and executive performance in elderly community residents: the PROOF study. Am J Geriatr Psychiatry 2014; 22: 1096–104. https://
Munshi MN, Hayes M, Iwata I, Lee Y, Weinger K. Which aspects of executive dysfunction influence ability to manage diabetes in older adults? Diabet Med. 2012; 29: 1171–1177. 5491.2012.03606.x.
Journals System - logo
Scroll to top