American Diabetes Association
03_B.6.1._supplemental_tables_05.28.21_RG_Listing.pdf (276.18 kB)

Association of Glycemia, Lipids, and Blood Pressure With Cognitive Performance in People With Type 2 Diabetes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study

Download (276.18 kB)
posted on 2021-07-20, 13:23 authored by José A. Luchsinger, Naji Younes, Jennifer J. Manly, Joshua Barzilay, Willy Valencia, Mary E. Larkin, Corinna Falck-Ytter, Heidi Krause-Steinrauf, Rodica Pop-Busui, Hermes Florez, Elizabeth Seaquist, the GRADE Research Group
Objective: Type 2 diabetes is a risk factor for cognitive impairment. We examined the relation of glycemia, lipids, blood pressure (BP), hypertension history, and statin use with cognition in the Glycemia Reduction Approaches in Diabetes: a comparative effectiveness study (GRADE).

Research Design and Methods: Cross-sectional analyses from GRADE at baseline examined the association of glycemia (hemoglobin A1c [HbA1c]), LDL, systolic (SBP) and diastolic (DBP) BP, hypertension history, and statin use with cognition assessed by the Spanish English Verbal Learning Test (SEVLT), letter (LF) and animal fluency (AF) tests, and Digit Symbol Substitution Test (DSST).

Results: Among 5,047 GRADE participants, 5,018 (99.4)% completed cognitive assessments. Their mean age was 56.7 ± 10.0 years, 36.4% were women. Mean diabetes duration was 4.0 ± 2.7 years. HbA1c was not related to cognition. Higher LDL was related to modestly worse DSST scores whereas statin use was related to modestly better DSST scores. SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg were related to modeslty better DSST scores. Hypertension history was not related to cognition.

Conclusions: In persons with type 2 diabetes with a mean duration of less than 5 years, lower LDL and statin use were related to modestly better executive cognitive function. SBP levels in the range of 120 to 139 mmHg, and DBP levels in the range of 80 to 89 mmHg, but not lower levels, were related to modeslty better executive function. These differences may not be clinically significant.


The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34DK088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926 , U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Usage metrics

    Diabetes Care


    Ref. manager