Both type 1 (T1D) and type 2 diabetes (T2D) impart significant risk for cognitive dysfunction. Adults experiencing diabetes-related complications in particular, have pronounced cognitive deficits. It is unknown whether multiple diabetes complications co-occur with cognitive dysfunction, specifically in youth-onset T1D and T2D. Using data from the SEARCH for Diabetes in Youth cohort study, we examined clustering of diabetes type, complications, and performance on cognitive tests in young adults with youth-onset T1D or T2D. Cognition was assessed via the NIH Toolbox Cognition Battery and age-corrected scores for composite fluid cognition were used. Diabetes complications included retinopathy, microalbuminuria, arterial stiffness, peripheral neuropathy, and cardiac autonomic neuropathy (CAN). Hierarchical clustering was applied with 795 participants (T1D=635; T2D=160). Three clusters emerged. Cluster 1 (C1; n=154) had the lowest composite fluid cognition scores, compared with Clusters 2 (C2; n=603) and 3 (C3; n=38) (mean [SD] 84.3 [17.7], 96.9 [15.7], 97.3 [16.2]; p<0.001). Compared with C2/C3, participants in C1 were predominantly young adults with T2D (79% vs. 4.6% and 28.9%, respectively; p<0.001), with higher prevalence of microvascular complications including, peripheral neuropathy (24% vs. 6.1% and 15.8%; p<0.001), retinopathy (24% vs. 12.3% and 13.2%; p=0.001), and microalbuminuria (24.7% vs. 6.5% and 10.5%; p<0.001). Compared with C1/C3, participants in C2 were predominantly young adults with T1D (95.4% vs. 21.4% and 71.1%; p<0.001). Compared with C1/C2, C3 was unique, with all participants having CAN (100% vs. 1.3% and 0%; p<0.001) and the highest average composite fluid cognition scores. Our data suggest that co-occurrence of microvascular complications coincide with worse cognitive function, especially in youth-onset T2D. Further research would be valuable to explore the relationship between CAN and cognitive performance.


A. Shapiro: None. S. M. Marcovina: None. A. D. Liese: None. A. K. Mottl: Advisory Panel; Self; Bayer U. S. E. T. Jensen: None. G. Wilkening: None. A. Bellatorre: None. D. Dabelea: None. J. M. Stafford: None. R. Dagostino: Consultant; Self; AstraZeneca, Biogen, Daiichi Sankyo. A. S. Shah: None. E. M. Urbina: None. C. E. Barrett: None. C. Pihoker: None.


Centers for Disease Control and Prevention (00097, DP-05-069, DP-10-001, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108173); Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01DP000246, U18DP002714); University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01DP000247, U18DP000247-06A1); Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01DP000248, 1U18DP002709); University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01DP000254, U18DP002708); Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01DP000244, U18DP002710-01); Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01DP000250, 200-2010-35171)

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