Allison L B Shapiro1,2, Dana Dabelea3,2,4, Jeanette M Stafford5, Ralph D'Agostino, Catherine Pihoker6, Angela D Liese7, Amy S Shah8, Anna Bellatorre2, Jean M Lawrence9, Leora Henkin5, Sharon Saydah10, Greta Wilkening. 1. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO allison.shapiro@cuanschutz.edu. 2. Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO. 3. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO. 4. Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO. 5. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC. 6. Department of Pediatrics, University of Washington, Seattle, WA. 7. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC. 8. Department of Pediatrics, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH. 9. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. 10. Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
OBJECTIVE: Poor cognition has been observed in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes (T2D) compared with control subjects without diabetes. Differences in cognition between youth-onset T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we tested the association between diabetes type and cognitive function in adolescents and young adults with T1D (n = 1,095) or T2D (n = 285). RESEARCH DESIGN AND METHODS: Cognition was assessed via the National Institutes of Health Toolbox Cognition Battery, and age-corrected composite Fluid Cognition scores were used as the primary outcome. Confounder-adjusted linear regression models were run. Model 1 included diabetes type and clinical site. Model 2 additionally included sex, race/ethnicity, waist-to-height ratio, diabetes duration, depressive symptoms, glycemic control, any hypoglycemic episode in the past year, parental education, and household income. Model 3 additionally included the Picture Vocabulary score, a measure of receptive language and crystallized cognition. RESULTS: Having T2D was significantly associated with lower fluid cognitive scores before adjustment for confounders (model 1; P < 0.001). This association was attenuated to nonsignificance with the addition of a priori confounders (model 2; P = 0.06) and Picture Vocabulary scores (model 3; P = 0.49). Receptive language, waist-to-height ratio, and depressive symptoms remained significant in the final model (P < 0.01 for all, respectively). CONCLUSIONS: These data suggest that while youth with T2D have worse fluid cognition than youth with T1D, these differences are accounted for by differences in crystallized cognition (receptive language), central adiposity, and mental health. These potentially modifiable factors are also independently associated with fluid cognitive health, regardless of diabetes type. Future studies of cognitive health in people with youth-onset diabetes should focus on investigating these significant factors.
OBJECTIVE: Poor cognition has been observed in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes (T2D) compared with control subjects without diabetes. Differences in cognition between youth-onset T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we tested the association between diabetes type and cognitive function in adolescents and young adults with T1D (n = 1,095) or T2D (n = 285). RESEARCH DESIGN AND METHODS: Cognition was assessed via the National Institutes of Health Toolbox Cognition Battery, and age-corrected composite Fluid Cognition scores were used as the primary outcome. Confounder-adjusted linear regression models were run. Model 1 included diabetes type and clinical site. Model 2 additionally included sex, race/ethnicity, waist-to-height ratio, diabetes duration, depressive symptoms, glycemic control, any hypoglycemic episode in the past year, parental education, and household income. Model 3 additionally included the Picture Vocabulary score, a measure of receptive language and crystallized cognition. RESULTS: Having T2D was significantly associated with lower fluid cognitive scores before adjustment for confounders (model 1; P < 0.001). This association was attenuated to nonsignificance with the addition of a priori confounders (model 2; P = 0.06) and Picture Vocabulary scores (model 3; P = 0.49). Receptive language, waist-to-height ratio, and depressive symptoms remained significant in the final model (P < 0.01 for all, respectively). CONCLUSIONS: These data suggest that while youth with T2D have worse fluid cognition than youth with T1D, these differences are accounted for by differences in crystallized cognition (receptive language), central adiposity, and mental health. These potentially modifiable factors are also independently associated with fluid cognitive health, regardless of diabetes type. Future studies of cognitive health in people with youth-onset diabetes should focus on investigating these significant factors.
Authors: Sandra Weintraub; Sureyya S Dikmen; Robert K Heaton; David S Tulsky; Philip D Zelazo; Patricia J Bauer; Noelle E Carlozzi; Jerry Slotkin; David Blitz; Kathleen Wallner-Allen; Nathan A Fox; Jennifer L Beaumont; Dan Mungas; Cindy J Nowinski; Jennifer Richler; Joanne A Deocampo; Jacob E Anderson; Jennifer J Manly; Beth Borosh; Richard Havlik; Kevin Conway; Emmeline Edwards; Lisa Freund; Jonathan W King; Claudia Moy; Ellen Witt; Richard C Gershon Journal: Neurology Date: 2013-03-12 Impact factor: 9.910