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Postprandial Glucose Fluctuations Impair Cognitive Functioning

Awareness and better control of postprandial glucose can help to prevent declining cognitive function. Tight control of postprandial glucose excursions by a short-acting oral antidiabetic drug (such as repaglinide) may be useful for preventing derangements in cognitive functioning." Wide fluctuations in postprandial glucose are associated with impaired cognitive functioning in older persons with type 2 diabetes, according to a report in the July issue of Neurology.

Previous studies have shown that older patients with type 2 diabetes are more likely than their nondiabetic counterparts to experience cognitive decline, the authors explain, but the mechanisms remain unclear.

Dr. A. M. Abbatecola and colleagues from Second University of Naples, Italy investigated whether postprandial glucose instability was associated with cognitive functioning in 156 older patients (60 to 78 years old) with type 2 diabetes treated with repaglinide or glibenclamide (glyburide).

Mini-Mental Status Examination (MMSE) scores correlated with variations in fasting plasma glucose and postprandial plasma glucose, the authors report, as did the cognition composite score. The correlations for both were stronger with increased variability of postprandial plasma glucose.

These associations between greater fluctuations in plasma glucose level and worse cognitive functioning persisted after adjusting for age, years of formal education, physical activity, depression, blood pressure, insulin sensitivity, and body mass index.
Repaglinide treatment was associated with stronger declines in postprandial glucose variability compared with glibenclamide treatment, the researchers note, and declines in MMSE and cognitive composite scores over time were significant only in the glibenclamide treatment group.

Intima medial thickness also increased significantly among patients treated with glibenclamide, but not in those treated with repaglinide, the report indicates.

"In older patients with type 2 diabetes, (fluctuations in) postprandial glucose values are strongly associated with global cognition as well as executive and attention functioning," the authors conclude. "Tight control of postprandial glucose excursions by a short-acting oral antidiabetic drug (such as repaglinide) may be useful for preventing derangements in cognitive functioning."

Neurology 2006;67:235-240.

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