IMPROVED DIABETES CONTROL IN THE ELDERLY DELAYS GLOBAL COGNITIVE DECLINE

To examine whether improved diabetes control is related to better cognitive outcomes. Design: Randomized control trial. Setting: A randomized trial of telemedicine vs. usual care in elderly persons with type 2 diabetes. Participants: Participants were 2169 persons 55 years and older with type 2 diabetes from New York City and Upstate New York. Intervention: The diabetes case management intervention was implemented by a diabetes nurse, via a telemedicine unit in the participant’s home, and in coordination with the primary care physician. Measurements: Hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL), were measured at a baseline visit and at up to 5 annual follow-up visits. Global cognition was measured at those visits with the Comprehensive Assessment and Referral Evaluation (CARE). Result: In mixed models the intervention was related to slower global cognitive decline in the intervention group (p = 0.01). Improvements in HbA1c (p = 0.03), but not SBP or LDL, mediated the effect of the intervention on cognitive decline. Conclusion: Improved diabetes control in the elderly following existing guidelines through a telemedicine intervention was associated with less global cognitive decline. The main mediator of this effect seemed to be improvements in HbA1c.