Latinx adults with both cognitive dysfunction and type 2 diabetes mellitus (T2DM) are significantly more likely than Latinx adults with diabetes alone to have complications such as cardiovascular disease. Glucose variability may be a risk for dementia, but the course of glucose variability in the time before a dementia diagnosis for Latinx adults with T2DM has not been examined. We used a 10-year retrospective cohort of medical records of Latinx patients with T2DM who had at least one use of a continuous glucose monitor. The objective was to examine how glucose variability was associated with future dementia diagnoses. A total of 116 charts were included. Mean of daily differences and mean amplitude of glycemic excursions were more strongly associated with dementia diagnoses than other variability indices (p < .01). Understanding the relationships between cognitive function, glucose variability, and barriers to health care can translate into improved interventions to enhance diabetes care.
AdolfssonP.RentoulD.KlinkenbijlB.ParkinC. G. (2018). Hypoglycemia remains the key obstacle to optimal glycaemic control—continuous glucose monitoring is the solution. European Journal of Endocrinology, 14(2), 50–56. https://doi.org/10.17925/EE.2018.14.2.50
2.
AleppoG.BeckR. W.BaileyR.RuedyK. J.CalhounP.PetersA. L.Pop-BusuiR.Philis-TsimikasA.BaoS.UpmierrezG.DavisG.KrugerD.BhargavaA.YoungL.BuseJ. B.McGillJ. B.MartensT.NguyeQ. T.OrozcoI. . . Type 2 Diabetes Basal Insulin Users: The Mobile Study (MOBILE) Study Group. (2021). The effect of discontinuing continuous glucose monitoring in adults with type 2 diabetes treated with basal insulin. Diabetes Care, 44(12), 2729–2737. https://doi.org/10.2337/dc21-1304
3.
American Diabetes Association. (2021). Diabetes technology: standards of medical care in diabetes—2021. Diabetes Care, 44(suppl 1), S85–S99. https://doi.org/10.2337/dc21-S007
4.
BattelinoT.DanneT.BergenstalR. M.AmielS. A.BeckR.BiesterT.BosiE.BuckinghamB. A.CefaluW. T.CloseK. L.CobelliC.DassauE.DeVriesJ. H.DonaghueK. C.DovcK.DoyleF. J.GargS.GrunbergerG.HellerS.. . . PhilipM. (2019). Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care, 42(8), 1593–1603. https://doi.org/10.2337/dci19-0028
5.
BlevinsT.LaneW.RodbardD.SindelarD.FanL.EllinorK.IlagL.LyT.JohnsonJ. (2021). Glucose variability and time in range in type 2 diabetes treated with U-500R by pump or injection: CGM findings from the VIVID study. Diabetes Technology & Therapeutics, 23(1), 51–58. https://doi.org/10.1089/dia.2020.0030
6.
CasagrandeS. S.MenkeA.Aviles-SantaL.GalloL. C.DaviglusM. L.TalaveraG. A.CasteñedaS. F.PerreiraK.LoopM. S.TarrafW.GonzálezH. M.CowieC. C. (2018). Factors associated with undiagnosed diabetes among adults with diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetes Research and Clinical Practice, 146, 258–266. https://doi.org/10.1016/j.diabres.2018.11.004
7.
CerielloA.MonnierL.OwensD. (2019). Glycaemic variability in diabetes: Clinical and therapeutic implications. Lancet Diabetes and Endocrinology, 7(3), 221–230. https://doi.org/10.1016/S2213-8587(18)30136-0
8.
ChibaK.NomotoH.NakamuraA.ChoK. Y.YamashitaK.ShibayamaY.MiyaA.KamedaH.KuriharaY.AokiS.AtsumiT.MiyoshiH. (2021). Sodium–glucose cotransporter 2 inhibitors reduce day-to-day glucose variability in patients with type 1 diabetes. Journal of Diabetes Investigation, 12(2), 176–183. https://doi.org/10.1111/jdi.13335
9.
CuevasH.HeitkemperE.HaqueB. (2022). Relationships among perception of cognitive function, diabetes self-management and glucose variability in older adults: A mixed-methods study. Research in Gerontological Nursing, 15(4), 203–212. https://doi.org/10.3928/19404921-20220609-02
10.
Cukierman-YaffeT.McClureL. A.RisoliT.BoschJ.SharmaM.GersteinH. C.BenaventeO. (2021). The relationship between glucose control and cognitive function in people with diabetes after a lacunar stroke. The Journal of Clinical Endocrinology & Metabolism, 106(4), e1521–e1528. https://doi.org/10.1210/clinem/dgab022
11.
DanneT.NimriR.BattelinoT.BergenstalR. M.CloseK. L.DeVriesJ. H.GargS.HeinemannL.HirschI.AmielS. A.BeckR.BosiE.BuckinghamB.CobelliC.DassauE.DoyleF. J.IIIHellerS.HovorkaR.JiaW.. . . PhillipM. (2017). International consensus on use of continuous glucose monitoring. Diabetes Care, 40(12), 1631–1640. https://doi.org/10.2337/dc17-1600
12.
GatlinP. K.InselK. C. (2015). Severity of type 2 diabetes, cognitive function, and self-care. Biological Research for Nursing, 17(5), 540–548. https://doi.org/10.1177/1099800414557565
13.
GonzálezH. M.TarrafW.GonzálezK. A.FornageM.ZengD.GalloL. C.TalaveraG. A.DaviglusM. L.LiptonR. B.KaplanR.RamosA. R.LamarM.CaiJ.DeCarliC.SchneidermanN. (2020). Diabetes, cognitive decline, and mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging results (HCHS/SOL). Diabetes Care, 43(5), 1111–1117. https://doi.org/10.2337/dc19-1676
14.
HandelsmanY.BloomgardenZ. T.GrunbergerG.UmpierrezG.ZimmermanR. S.BaileyT. S.BlondeL.BrayG. A.CohenA. J.Dagogo-JackS.DavidsonJ. A.EinhornD.GandaO. P.GarberA. J.GarveyW. T.HenryR. R.HirschI. B.HortonE. S.HurleyD. L.. . . ZangenehF. (2015). American association of clinical endocrinologists and American college of endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocrine Practice, 21(suppl 1), S1–S87.
15.
HendrieH. C.ZhengM.LaneK. A.AmbuehlR.PurnellC.LiS.UnverzagtF. W.MurrayM. D.BalasubramanyamA.CallahanC. M.GaoS. (2018). Changes of glucose levels precede dementia in African Americans with diabetes, but not in Caucasians. Alzheimer’s & Dementia, 14(12), 1572–1579. https://doi.org/10.1016/j.jalz.2018.03.008
16.
HooverS.SanoM. (2019). After the diagnosis: Considerations in disease management. In RavdinL. D.KatzenH. L. (Eds.), Handbook on the neuropsychology of aging and dementia. Springer, Cham.
17.
IsaacsD.BelliniN. J.BibaU.CaiA.CloseK. L. (2021). Health care disparities in use of continuous glucose monitoring. Diabetes Technology & Therapeutics, 23(suppl 3), S81–S87. https://doi.org/10.1089/dia.2021.0268
18.
JohnsonM. L.MartensT. W.CriegoA. B.CarlsonA. L.SimonsonG. D.BergenstalR. M. (2019). Utilizing the ambulatory glucose profile to standardize and implement continuous glucose monitoring in clinical practice. Diabetes Technology & Therapeutics, 21(suppl 2), S217–S225. https://doi.org/10.1089/dia.2019.0034
19.
KimM. J.FritschiC. (2021). Relationships between cognitive impairment and self-management in older adults with type 2 diabetes: An integrative review. Research in Gerontological Nursing, 14(2), 104–112. https://doi.org/10.3928/19404921-20201117-01
20.
KindA. J. H.BuckinghamW. R. (2018). Making neighborhood-disadvantage metrics accessible—the Neighborhood Atlas. New England Journal of Medicine, 378(26), 2456–2458. https://doi.org/10.1056/NEJMp1802313
21.
KovatchevB.CobelliC. (2016). Glucose variability: Timing, risk analysis, and relationship to hypoglycemia in diabetes. Diabetes Care, 39(4), 502–510. https://doi.org/10.2337/dc15-2035
22.
KrugerD. F.AndersonJ. E. (2021). Continuous glucose monitoring (CGM) is a tool, not a reward: Unjustified insurance coverage criteria limit access to CGM. Diabetes Technology & Therapeutics, 23(suppl 3), S45–S55. https://doi.org/10.1089/dia.2021.0193
23.
LamarM.Durazo-ArvizuR. A.SachdevaS.PirzadaA.PerreiraK. M.RundekT.GalloL. C.GroberE.DeCarliC.LiptonR. B.TarrafW.GonzálezH. M.DaviglusM. L. (2019). Cardiovascular disease risk factor burden and cognition: Implications of ethnic diversity within the Hispanic Community Health Study/Study of Latinos. PLoS One, 14(4), e0215378.
24.
LeeD. Y.KimJ.ParkS.ParkS. Y.YuJ. H.SeoJ. A.KimH. K.YooH. J.KimS. G.ChoiK. M.BaikS. H.HanK.KimN. H. (2022). Fasting glucose variability and the risk of dementia in individuals with diabetes: A nationwide cohort study. Diabetes & Metabolism Journal. Advance online publication. https://doi.org/10.4093/dmj.2021.0346
25.
LimJ. S.KimC.OhM. S.LeeJ. H.JungS.JangM. U.LeeS. H.KimY. J.KimY.SuhS. W.LeeB. C.YuK. H. (2018). Effects of glycemic variability and hyperglycemia in acute ischemic stroke on post-stroke cognitive impairments. Journal of Diabetes and its Complications, 32(7), 682–687. https://doi.org/10.1016/j.jdiacomp.2018.02.006
26.
LuchsingerJ. A.CabralR.EimickeJ. P.ManlyJ. J.TeresiJ. (2015). Glycemia, diabetes status, and cognition in Hispanic adults aged 55–64 years. Psychosomatic Medicine, 77(6), 653–663. https://doi.org/10.1097/psy.0000000000000208
27.
MangrolaD. M.CoxC.FurmanA. S.KrishnanS.KarakasS. E. (2018). Self blood glucose monitoring underestimates hyperglycemia and hypoglycemia as compared to continuous glucose monitoring in type 1 and type 2 diabetes. Endocrine Practice, 24(1), 47–52. https://doi.org/10.4158/EP-2017-0032
28.
MatsubaraM.MakinoH.WashidaK.MatsuoM.KoezukaR.OhataY.TamanahaT.Honda-KohmoK.NoguchiM.TomitaT.SonC.NakaiM.NishimuraK.MiyamotoY.IharaM.HosodaK. (2020). A prospective longitudinal study on the relationship between glucose fluctuation and cognitive function in type 2 diabetes: PROPOSAL study protocol. Diabetes Therapy, 11(11), 2729–2737. https://doi.org/10.1007/s13300-020-00916-9
29.
MattishentK.LokeY. K. (2016). Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: A systematic review and meta-analysis. Diabetes, Obesity, & Metabolism, 18(2), 135–141. https://doi.org/10.1111/dom.12587
30.
MianZ.HermayerK. L.JenkinsA. (2019). Continuous glucose monitoring: Review of an innovation in diabetes management. The American Journal of the Medical Sciences, 358(5), 332–339. https://doi.org/10.1016/j.amjms.2019.07.003
31.
MillerE. M. (2020). Using continuous glucose monitoring in clinical practice. Clinical Diabetes, 38(5), 429–438. https://doi.org/10.2337/cd20-0043
32.
OharaM.FukuiT.OuchiM.WatanabeK.SuzukiT.YamamotoS.YamamotoT.HayahsiT.ObaK.HiranoT. (2016). Relationship between daily and day-to-day glycemic variability and increased oxidative stress in type 2 diabetes. Diabetes Research and Clinical Practice, 122, 62–70. https://doi.org/10.1016/j.diabres.2016.09.025
33.
RawlingsA. M.SharretA. R.AlbertM. S.CoreshJ.WindhamG.PowerM. C.KnopmanD. S.WalkerK.BurgardS.MosleyT. H.GottesmanR. G.SelvinE. (2019). The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: The ARIC study. Diabetes Care, 42(7), 1248–1254. https://doi.org/10.2337/dc19-0120
34.
RutterM. K. (2018). Devoting attention to glucose variability and hypoglycaemia in type 2 diabetes. Diabetologia, 61(1), 43–47. https://doi.org/10.1007/s00125-017-4421-1
35.
SheladiaS.ReddyP. H. (2021). Age-related chronic diseases and Alzheimer’s disease in Texas: A Hispanic focused study. Journal of Alzheimer’s Disease Reports, 5(1), 121–133. https://doi.org/10.3233/ADR-200277
36.
SimonsonG. D.BergenstalR. M.JohnsonM. L.DavidsonJ. L.MartensT. W. (2021). Effect of professional CGM (pCGM) on glucose management in type 2 diabetes patients in primary care. Journal of Diabetes Science and Technology, 15(3), 539–545. https://doi.org/10.1177/1932296821998724
37.
SinghG. K. (2003). Area deprivation and widening inequalities in US mortality, 1969–1998. American Journal of Public Health, 93(7), 1137–1143. https://doi.org/10.2105/ajph.93.7.1137
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