Cognition Similar for Standard, Intensive Glycemic Control

Total brain volume, mortality risk higher with intensive glycemic lowering for type 2 diabetes

WEDNESDAY, Sept. 28 (HealthDay News) -- Intensive glycemic lowering is not better than standard glycemic control for preventing cognitive decline in patients with type 2 diabetes, despite a higher total brain volume, according to a study published online Sept. 28 in The Lancet Neurology.

Lenore J. Launer, Ph.D., from the National Institutes of Health in Bethesda, Md., and colleagues investigated the effects of intensive versus standard glycemic control on cognitive function and brain volumes in 2,977 participants (aged 55 to 80 years) with type 2 diabetes, high glycated hemoglobin A1c concentrations (>7.5 percent, >58 mmol/mol), who were at high risk for cardiovascular disease. The primary outcome, cognitive ability, was assessed in 1,378 patients assigned to intensive treatment and 1,416 assigned to standard treatment at baseline, 20, and 40 months, using the Digit Symbol Substitution Test (DSST). A subset of 614 patients with baseline magnetic resonance imaging (MRI), 230 and 273 of which were assigned to intensive and standard treatments, respectively, underwent assessment for total brain volume (TBV) at 40 months. In February 2008, all participants were switched to standard treatment owing to a high mortality risk in the intensive strategy group.

The investigators found that the mean 40-month DSST scores were not significantly different between the two treatment groups. The mean TBV was significantly greater for the intensive-treatment group than for the standard-treatment group.

"Although significant differences in TBV favored the intensive treatment, cognitive outcomes were not different," the authors write.

One of the study authors disclosed financial relationships with the pharmaceutical industry.

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