The cross-sectional association of renal dysfunction with tests of cognition in middle-aged adults with early type 2 diabetes: The GRADE Study

the GRADE Research Group

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Abstract

Objective: The association of renal dysfunction with tests of cognition in type 2 diabetes has been examined in individuals with moderate and advanced renal disease. Here we examine the association of renal dysfunction with tests of cognition in a cohort of middle-aged adults with short duration diabetes (mean 4.0 ± 2.8 years). Methods: Baseline data were examined from the Glycemia Reduction Approaches in Diabetes (GRADE) study (n = 4998). Renal dysfunction was defined by the presence of albumin in the urine or by estimated glomerular filtration rate (eGFR). Cognition was assessed with the Spanish English Verbal Learning Test, Letter and Animal fluency tests, and the Digit Symbol Substitution Test. Results: Participants with albuminuria or eGFR <60 ml/min/1.73 m2 had significantly lower test scores of information processing speed and perception, executive function and ability to categorize information, and of verbal learning and memory compared to participants without renal disease. Adjustment for hypertension, dyslipidemia, and waist circumference attenuated many of these findings but markers of impaired learning and executive function continued to remain lower in association with higher urine albumin levels. Conclusion: In type 2 diabetes of short duration, there are already subtle deficiencies in markers of cognition in association with renal disease in middle aged adults.

Original languageEnglish (US)
Article number107805
JournalJournal of Diabetes and Its Complications
Volume35
Issue number3
DOIs
StatePublished - Mar 2021

Bibliographical note

Funding Information:
Declaration of competing interest: RPB reports grants from National Institute of Diabetes and Digestive and Kidney Diseases , NIH ( U34 DK088043 and U01 DK098246 ) during the conduct of the study; grants from Astra Zeneca, personal fees from Novo Nordisk, Bayer, and Boehringer Ingelheim outside the submitted work. ES reports other support from MannKind, Zucara, ABIM, Web MD, Sanofi, and grants and other support from Lilly, outside the submitted work. JAL reports personal fees from vTV Therapeutics, and other support from Wolters Kluwer, outside the submitted work. JIB owns shares of Merck. HF, NY, and CFY have nothing to disclose.

Funding Information:
Declaration of competing interest: RPB reports grants from National Institute of Diabetes and Digestive and Kidney Diseases, NIH (U34 DK088043 and U01 DK098246) during the conduct of the study; grants from Astra Zeneca, personal fees from Novo Nordisk, Bayer, and Boehringer Ingelheim outside the submitted work. ES reports other support from MannKind, Zucara, ABIM, Web MD, Sanofi, and grants and other support from Lilly, outside the submitted work. JAL reports personal fees from vTV Therapeutics, and other support from Wolters Kluwer, outside the submitted work. JIB owns shares of Merck. HF, NY, and CFY have nothing to disclose.JIB and NY are the guarantors of this work and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01-DK-098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34-DK-088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There has been no prior presentation of this material.

Funding Information:
The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01-DK-098246 . The planning of GRADE was supported by a U34 planning grant from the NIDDK ( U34-DK-088043 ). The America n Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44 , P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Albuminuria
  • Cognitive impairment
  • Diabetes
  • Insulin resistance
  • Reduced eGFR

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