Background

Studies examining whether measures of cognition are related to the presence of diabetic peripheral neuropathy (DPN) and/or cardiovascular autonomic neuropathy (CAN) are lacking, as are data regarding factors potentially explaining such associations.

Methods

Participants were from the Glycemia Reduction Approaches in Diabetes Study (GRADE) that examined 5047 middle-aged people with type 2 diabetes of <10 years of known duration. Verbal learning and immediate and delayed recall (memory) were assessed with the Spanish English Verbal Learning Test; frontal executive function and processing speed with the Digit Symbol Substitution Test; and ability to concentrate and organize data with word and animal fluency tests. DPN was assessed with the Michigan Neuropathy Screening Instrument and CAN by indices of heart rate variability (standard deviation of normal beat to beat variation [SDNN] and root mean square of successive differences [RMSSD]).

Results

DPN was significantly inversely related to measures of immediate recall and processing speed. The percent of cognitive variation explained by DPN was small. Tests of CAN had an inconsistent or absent association with measures of cognition. Higher waist circumference and urine albumin creatinine (UACR) levels were the strongest correlates in the relationship between DPN and cognitive impairment.

Conclusion

DPN, but not CAN, was cross-sectionally associated with lower performance in measures of cognition in people with type 2 diabetes of <10 years of known duration. Greater waist circumference and UACR were important variables in this association. The mechanisms underlying the cross-sectional association of DPN with cognitive impairment are unknown.

Clinicaltrials.gov: NCT01794143

中文翻译：

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认知与糖尿病周围神经病变和自主神经病变的横断面关联——GRADE 研究

背景

缺乏关于认知测量是否与糖尿病周围神经病变 (DPN) 和/或心血管自主神经病变 (CAN) 的存在相关的研究，以及有关可能解释此类关联的因素的数据。

方法

参与者来自糖尿病研究 (GRADE) 中的血糖降低方法，该研究检查了 5047 名患有已知病程 <10 年的 2 型糖尿病的中年人。语言学习和即时和延迟回忆（记忆）通过西班牙英语语言学习测试进行评估；数字符号替代测试的额叶执行功能和处理速度；以及通过文字和动物流畅性测试集中和组织数据的能力。DPN 使用密歇根神经病变筛查仪和 CAN 通过心率变异性指标（正常搏动间变异的标准差 [SDNN] 和连续差的均方根 [RMSSD]）进行评估。

结果

DPN 与即时回忆和处理速度的测量值显着负相关。DPN 解释的认知变异百分比很小。CAN 测试与认知测量的关联不一致或不存在。较高的腰围和尿白蛋白肌酐 (UACR) 水平是 DPN 与认知障碍之间关系的最强相关因素。

结论

DPN，但不是 CAN，与已知病程 <10 年的 2 型糖尿病患者的认知测量表现较差横断面相关。更大的腰围和 UACR 是该关联中的重要变量。DPN 与认知障碍的横断面关联的潜在机制尚不清楚。

临床试验.gov：NCT01794143