Type 2 diabetes linked to worse cognitive performance after a stroke; prediabetes not linked, but prevention needed

May 14, 2020

DALLAS, May 14, 2020 -- People with Type 2 diabetes, but not those with prediabetes, had worse cognitive performance three to six months after a stroke than those with normal fasting blood sugar levels, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

"Type 2 diabetes increases the risk of stroke and has been associated with cognitive impairment and may increase dementia risk. That's why Type 2 diabetes is another important target in the prevention of dementia, and the focus should be on early treatment for prediabetes to delay or prevent the progression to Type 2 diabetes," said Perminder Sachdev, M.D., Ph.D., senior author of the study and Scientia professor at UNSW Sydney's Centre for Healthy Brain Ageing (CHeBA) in Kensington, Australia.

Previous research by Sachdev and colleagues found that stroke patients with a history of Type 2 diabetes have worse cognitive function compared to stroke patients without Type 2 diabetes.

"In this study, we wanted to know if stroke patients with prediabetes also have worse cognitive function compared to stroke patients without prediabetes or diabetes," Sachdev said. "This is important because prediabetes is very common, and individuals can have prediabetes for several years before progressing to Type 2 diabetes. Early and aggressive treatment of prediabetes can delay or prevent Type 2 diabetes. If we target the treatment of prediabetes, could this prevent the development of dementia in some individuals?" said Sachdev.

Researchers combined data from 1,601 stroke patients (average age 66; 63% male; 70% Asian; 26% white; 2.6% African American) who participated in one of seven international studies from six countries. Almost all had clot-caused strokes, and a variety of cognitive functions were assessed between three to six months after the stroke. Patients' fasting blood sugar levels measured at hospital admission and medical history were used to define Type 2 diabetes and prediabetes.

After adjusting for age, sex and education, researchers found: "The deficits we found in all areas of cognitive function highlight the importance of assessing the capacity for self-care in patients with Type 2 diabetes following a stroke," said Jess Lo, M.Sc., lead author of the study and research associate at UNSW Sydney's Centre for Healthy Brain Ageing (CHeBA), in Kensington, Australia. "We need to ensure that stroke survivors have the mental competency to manage the complex and intertwined tasks to effectively treat Type 2 diabetes, which can include measuring glucose levels multiple times a day, managing glucose monitoring devices, adjusting medication doses, self-administering insulin or other medications, and understanding food labels and portion sizes to adjust what is eaten at each meal or snack."

"While our study is focused on cognition after a stroke, there is strong evidence that Type 2 diabetes is associated with cognitive impairment. This is an important message for the general public. Since our study shows no evidence that prediabetes is associated with worse cognitive performance, this emphasizes the importance of the early diagnosis and treatment of prediabetes (which is often under-diagnosed) in order to delay or prevent the progression to Type 2 diabetes," Lo said.

The study is limited by not having information on the duration and severity of diabetes, and having only one measurement of blood sugar levels.
-end-
The seven studies included in the analysis are part of an international collaboration called STROKOG. The studies were conducted in Australia, France, Korea, the Netherlands, Singapore and the United States.

Other co-authors are John D. Crawford, Ph.D.; Katherine Samaras, Ph.D.; David W. Desmond, Ph.D.; Sebastian Köhler, Ph.D.; Julie Staals, M.D. Ph.D.; Frans Verhey, M.D., Ph.D.; Hee-Joon Bae, M.D., Ph.D.; Keon-Joo Lee, M.D.; Beom Joon Kim, M.D., Ph.D.; Régis Bordet, M.D., Ph.D.; Charlotte Cordonnier, M.D., Ph.D.; Thibaut Dondaine, Ph.D.; Anne-Marie Mendyk, R.N.; Byung-Chul Lee, M.D., Ph.D.; Kyung-Ho Yu, M.D., Ph.D.; Jae-Sung Lim, M.D.; Nagaendran Kandiah, F.R.C.P.; Russell J. Chander, B.A.; Chathuri Yatawara, Ph.D.; and Darren M. Lipnicki, Ph.D.

The study was funded by the Vincent Fairfax Family Foundation and the National Health and Research Council of Australia.

Additional Resources:Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook and Twitter.

American Heart Association

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.