The mean amplitude of glycemic excursions (MAGE) is a significant deter-minant of overall metabolic control as well as increased risk for diabetes complications. Older
individuals with type 2 diabetes are more likely to have moderate cognitive deficits and structural
changes in brain tissue. Considering that poor metabolic control is considered a deranging factor
for cognitive performance in diabetic patients, we evaluated whether the contributions of MAGE
to cognitive status in older patients with type 2 diabetes were independent from the main
markers of glycemic control, such as sustained chronic hyperglycemia (A1C), postprandial
glycemia (PPG), and fasting plasma glucose (FPG)RESEARCH DESIGN AND METHODS — In 121 older patients with type 2 diabetes,
48-h continuous subcutaneous glucose monitoring (CSGM) were assessed. MAGE and PPG were
evaluated during CSGM. The relationship of MAGE to performance on cognitive tests was
assessed, with adjustment for age, glycemic control markers, and other determinants of cognitive
status. The cognitive tests were a composite score of executive and attention functioning and the
Mini Mental Status Examination (MMSE).
RESULTS — MAGE was significantly correlated with MMSE (r * 0.83; P * 0.001) and with
cognition composite score (r * 0.68; P * 0.001). Moreover, MAGE was associated with the
MMSE (P * 0.001) and cognition composite score (P * 0.001) independently of age, sex, BMI,
waist-to-hip (WHR) ratio, drug intake, physical activity, mean arterial blood pressure, FPG, PPG,
and A1C.
CONCLUSIONS — MAGE during a daily period was associated with an impairment of
cognitive functioning independent of A1C, FPG, and PPG. The present data suggest that inter-ventional trials in older patients with type 2 diabetes should target not only A1C, PPG, and FPG
but also daily acute glucose swing