Poor cognition has been observed in children and adolescents with type 1 (T1D) and type 2 (T2D) diabetes. Differences in cognition between young adults with youth-onset T1D and T2D, however, have not been explored, nor is the effect of shared etiologic processes, e.g., poor glycemic control, on cognition fully understood. Using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we compared cognition between young adults with youth-onset T1D and T2D, testing whether glycemic control modified the relationship between diabetes type and cognition. Cognition was assessed via the NIH Toolbox Cognition Battery and age-corrected composite Fluid Cognition scores used. Glycemic control was estimated from repeated measures of HbA1c. Linear regression modeling was used to test the interaction effect of diabetes type and glycemic control on Fluid Cognition score while controlling for sex, race/ethnicity, waist-height ratio, duration of diabetes, depression, alcohol and drug use, any hypoglycemic episode in the past year, parental highest level of education, household income, and clinic site. The T2D group (n = 254) had significantly lower Fluid Cognition scores, compared to the T1D group (n = 953) (mean [SD] 84.7 [17.3] vs. 95.4 [16.8], p<0.001). Glycemic control modified the relationship between diabetes type and Fluid Cognition scores (interaction p=0.16). Using the model’s interaction estimates, at a HbA1c of 6.5%, the T2D group demonstrated significantly lower Fluid Cognition scores, compared to the T1D group (β = -6.54, 95% CI: -11.52, -1.57, p=0.01). At a HbA1c of 9.5%, Fluid Cognition scores in the T2D group differed to a lesser extent from the T1D group (β = -3.61, 95% CI: -7.16, -0.06, p=0.05). Youth with T2D had poorer cognition then youth with T1D. This effect is more pronounced at lower HbA1c levels. Our findings suggest that factors unique to youth-onset T2D may impact cognition in this specific diabetes group, warranting further investigation.
A. Shapiro: None. D. Dabelea: None. J.M. Stafford: None. R. Dagostino: Consultant; Self; Amgen, AstraZeneca, Celgene, Daiichi Sankyo. C. Pihoker: None. A.D. Liese: None. A.S. Shah: None. A. Bellatorre: None. J.M. Lawrence: None. L. Henkin: None. G. Wilkening: None.
National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108173-01)