The association of insulin responses and insulin sensitivity with cognition in adults with pre-diabetes: The Diabetes Prevention Program Outcomes Study

Authors

Allison L. Shapiro, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado at Anschutz (CU-Anschutz), USA; Section of Endocrinology, Department of Pediatrics, School of Medicine, CU-Anschutz, USA. Electronic address: dppmail@bsc.gwu.edu.
Ashley H. Tjaden, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA.
Sharon L. Edelstein, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA.
Steven E. Kahn, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA.
Preethi Srikanthan, Division of Endocrinology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
William C. Knowler, Consultant: Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA.
Elizabeth M. Venditti, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Sherita H. Golden, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Owen Carmichael, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
José A. Luchsinger, Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.

Document Type

Journal Article

Publication Date

6-1-2024

Journal

Journal of diabetes and its complications

Volume

38

Issue

6

DOI

10.1016/j.jdiacomp.2024.108764

Keywords

Cognitive function; Insulin response; Pre-diabetes

Abstract

OBJECTIVE: Dysglycemia is a significant risk factor for cognitive impairment. However, which pathophysiologic determinant(s) of dysglycemia, impaired insulin sensitivity (ISens) or the islet β-cell's response (IResp), contribute to poorer cognitive function, independent of dysglycemia is not established. Among 1052 adults with pre-diabetes from the Diabetes Prevention Program Outcomes Study (DPPOS), we investigated the relationship between IResp, ISens and cognitive function. RESEARCH DESIGN AND METHODS: IResp was estimated by the insulinogenic index (IGI; pmol/mmol) and ISens as 1/fasting insulin from repeated annual oral glucose tolerance tests. The mean IResp and mean ISens were calculated over approximately 12 years of follow-up. Verbal learning (Spanish-English Verbal Learning Test [SEVLT]) and executive function (Digital Symbol Substitution Test [DSST]) were assessed at the end of the follow-up period. Linear regression models were run for each cognitive outcome and were adjusted for dysglycemia and other factors. RESULTS: Higher IResp was associated with poorer performance on the DSST (-0.69 points per 100 unit increase in IGI, 95 % CI: -1.37, -0.01). ISens was not associated with DSST, nor were IResp or ISens associated with performance on the SEVLT. CONCLUSIONS: These results suggest that a greater β-cell response in people at high risk for type 2 diabetes is associated with poorer executive function, independent of dysglycemia and ISens.

APA Citation

Shapiro, Allison L.; Tjaden, Ashley H.; Edelstein, Sharon L.; Kahn, Steven E.; Srikanthan, Preethi; Knowler, William C.; Venditti, Elizabeth M.; Golden, Sherita H.; Carmichael, Owen; and Luchsinger, José A., "The association of insulin responses and insulin sensitivity with cognition in adults with pre-diabetes: The Diabetes Prevention Program Outcomes Study" (2024). GW Authored Works. Paper 4860.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4860

Department

Biostatistics and Bioinformatics