Ethnicity/culture modulates the relationships of the haptoglobin (Hp) 1-1 phenotype with cognitive function in older individuals with type 2 diabetes

Ethnic and Racial Disparities in the Association between Type II Diabetes Mellitus and Dementia

Evidence in the literature suggests an association between Type 2 Diabetes Mellitus (T2DM) and dementia, but this relationship has not been studied in the most recently available nationally representative datasets. This retrospective, observational, cross-sectional study of adults (60+ years of age) seeks to investigate this association across racial and ethnic groups in the most recently available National Ambulatory Medical Care Survey (NAMCS) datasets. A multivariable logistic regression model is employed to investigate the association between T2DM and the diagnosis of dementia and assess disparities in racial and ethnic groups, while controlling for available covariates of interest. The analysis found no evidence of a relationship between T2DM and dementia even after adjusting for available covariates of interest (OR 1.13, 95% CI = 0.81-1.57). However, evidence of differences in the proportion with dementia was observed between ethnicities and race groups. Hispanic/Latinos were found to have more than double the odds of dementia compared to Non-Hispanic/Latinos (OR 2.08, 95% CI = 1.05-4.14), while the Other race group had 74% lower odds of dementia compared to the White race group (OR 0.26, 95% CI = 0.10-0.64). This study suggests that disparities in the risk of dementia remain for ethnic/racial groups. As minority populations continue to grow, educational and preventative measures for both diabetes and dementia are vital public health priorities. Perceptions of cognitive impairment, its association with T2DM, and the interventions needed to address the deficits may vary by culture and ethnic background; therefore, specific characteristics relevant to these populations should be further evaluated.

Executive Function and Diabetes: A Clinical Neuropsychology Perspective

Objective

Diabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications.

Methods

Herein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, management tools, and intervention targets for diabetes management. We also discuss the implications for clinical practice.

Results

In both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline.

Conclusion

Further studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle.

Predicting medication adherence in older Hispanic patients with type 2 diabetes

PURPOSE

Potential cognitive and demographic correlates of medication nonadherence in older Hispanic adults with type 2 diabetes were investigated.

METHODS

Forty community-dwelling participants 65 years of age or older were recruited. Executive control function (ECF) was assessed using the executive clock drawing task (CLOX 1) test and the 25-item Executive Interview. Self-reported medication adherence was measured on a visual analog scale (VAS); measures of glycemic control included glycosylated hemoglobin (HbA_1c) concentration. The primary objective was to determine if ECF performance correlated with medication adherence or glycemic control.

RESULTS

Participants' mean ± S.D. age was 74.95 ± 7.07 years, and 73% (n = 29) were female. Lower VAS scores correlated with worse CLOX 1 performance (r = 0.38, p = 0.02) and worse HbA_1c status (r = -0.42, p = 0.007). Linear regression modeling indicated significant associations between VAS scores and both CLOX 1 results (beta coefficient [β] = 0.41, p = 0.01) and educational level (β = 0.345, p = 0.03). Receiver operating characteristic analysis of CLOX 1 scores (scoring range, 0-15; lower scores indicate greater impairment) showed that a highly sensitive cutoff score for predicting adherence of <90% would be 7, but a cutoff of 10 would provide more specificity.

CONCLUSION

Results of an evaluation of a small sample of Hispanic older adults with type 2 diabetes demonstrated a relationship between ECF, as measured by the CLOX 1 instrument, and self-reported medication adherence.

Haptoglobin phenotype influences the effectiveness of diet-induced weight loss in middle-age abdominally obese women with metabolic abnormalities

BACKGROUND & AIMS

Haptoglobin (Hp) is associated with risks of obesity and cardiometabolic dysfunction; however, the role of the Hp phenotype in diet-induced weight loss remains to be elucidated. This study investigated whether the Hp phenotype contributes to inter-individual variations in body weight reduction as well as changes in the metabolic profile.

METHODS

Secondary data analysis from a randomized controlled trial. In total, 151 abdominally obese Taiwanese women with ≥2 metabolic components were randomized to each of four dietary programs [calorie restriction (CR), calorie restriction plus fish oil supplementation (CRF), calorie restricted meal replacement (CRMR), and calorie restricted meal replacement with fish oil supplementation (CRMRF)] for 12 weeks. Abdominal obesity was defined as a waist circumference (WC) ≥ 80 cm in women. Hp phenotyping was performed by plasma gel electrophoresis.

RESULTS

The prevalence of the Hp 1-1, 2-1, and 2-2 phenotypes were 12.58%, 41.06% and 46.35%, respectively. The mean age was 50.59 ± 12.22 years, and mean reduction in the percent body weight was 4.7% ± 3.8%. The Hp 1-1 phenotype exhibited significant decreases in the WC, body fat mass, plasma insulin levels, free hemoglobin and homeostatic model assessment of insulin resistance (HOMA-IR) compared to the Hp 2-1 or Hp 2-2 phenotypes after adjusting for the baseline age, WC, metabolic syndrome (MetS), and dietary programs (all adjusted p < 0.05). A greater improvement in the prevalence of central obesity and, to a lesser extent, MetS was also found in women with the Hp 1-1 phenotype.

CONCLUSIONS

Obese women with the Hp 1-1 phenotype might obtain greater benefits in terms of reducing abdominal fat and improving insulin sensitivity in response to hypocaloric diet-induced weight reduction. The findings from this study support potential gene-diet interactions affecting weight loss. This trial was registered at ClinicalTrials.gov as NCT01768169.

CLINICAL TRIAL REGISTRY

This trial was registered at ClinicalTrials.gov as NCT01768169.