Continuous glucose monitoring and cognitive performance in type 2 diabetes

Background: Type 2 diabetes is associated with reductions in cognitive function that are associated with glycated hemoglobin (HbA1c) levels, but there is no information on whether cognition is related to postmeal glucose spikes. We explored the relationship of cognition to glucose levels measured by a continuous glucose monitoring system (CGMS) both before and after a weight loss diet. Subjects and Methods: Forty-four white subjects with type 2 diabetes (59.0±6.2 years old; body mass index, 32.8±4.2 kg/m²; HbA1c, 6.9±1.0%) completed an 8-week energy-restricted (approximately 6-7 MJ, 30% deficit) diet. Cognitive functioning (short-term memory, working memory, speed of processing [inspection time], psychomotor speed, and executive function) was assessed during four practice sessions, baseline, and Week 8. Parallel glucose levels were attained using the CGMS in 27 subjects. Outcomes were assessed by fasting blood glucose (FBG), postprandial peak glucose (G _max), time spent >12 mmol/L (T>12), and 24-h area under the glucose curve (AUC₂₄). Results: Despite a fall in FBG of 0.65 mmol/L after 8 weeks, digits backward results correlated with FBG at both Week 0 and Week 8 (r=-0.43, P<0.01 and r=-0.32, P<0.01, respectively). Digits forward results correlated with FBG (r=-0.39, P<0.01), G_max (r=-0.46, P<0.05), and AUC₂₄ (r=-0.50, P<0.01) at Week 0 and FBG (r=-0.59, P<0.001), G_max (r=0.37, P=0.01), AUC₂₄ (r=-0.41, P<0.01), and percentage weight loss (r=0.31, P<0.01) at Week 8. Cognitive function was not altered by weight loss, gender, baseline lipid levels, or premorbid intelligence levels (National Adult Reading Test). Conclusions: FBG, G_max, and AUC₂₄ were related to cognitive function and an energy-restricted diet for 8 weeks did not alter this relationship.