Metformin, lifestyle intervention, and cognition in the diabetes prevention program outcomes study

for the Diabetes Prevention Program Research Group

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: We examined the association of the Diabetes Prevention Program(DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. Research Design and Methods: The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. Results: A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 6 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ϵ4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) andmetformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. Conclusions: Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.

Original languageEnglish (US)
Pages (from-to)958-965
Number of pages8
JournalDiabetes Care
Volume40
Issue number7
DOIs
StatePublished - Jul 1 2017

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Metformin
Cognition
Life Style
Outcome Assessment (Health Care)
Placebos
Type 2 Diabetes Mellitus
Social Adjustment
Verbal Learning
North American Indians
Glycosylated Hemoglobin A
Random Allocation
Hispanic Americans
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Metformin, lifestyle intervention, and cognition in the diabetes prevention program outcomes study. / for the Diabetes Prevention Program Research Group.

In: Diabetes Care, Vol. 40, No. 7, 01.07.2017, p. 958-965.

Research output: Contribution to journalArticle

for the Diabetes Prevention Program Research Group. / Metformin, lifestyle intervention, and cognition in the diabetes prevention program outcomes study. In: Diabetes Care. 2017 ; Vol. 40, No. 7. pp. 958-965.
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abstract = "Objective: We examined the association of the Diabetes Prevention Program(DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. Research Design and Methods: The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. Results: A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 6 10.7 years underwent cognitive assessments; 67.7{\%} women, 54.6{\%} non-Hispanic white, 20.7{\%} non-Hispanic black, 14.6{\%} Hispanic, 5.5{\%} American Indian, and 4.6{\%} Asian; 26.6{\%} were homozygous or heterozygous for APOE-ϵ4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9{\%}; P < 0.001) compared with lifestyle (47.0{\%}) andmetformin (50.4{\%}). Metformin exposure was higher in the metformin group (8.72 years; P 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. Conclusions: Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.",
author = "{for the Diabetes Prevention Program Research Group} and Luchsinger, {Jos{\'e} A.} and Yong Ma and Christophi, {Costas A.} and Florez, {Hermes J} and Golden, {Sherita H.} and Helen Hazuda and Jill Crandall and Elizabeth Venditti and Karol Watson and Susan Jeffries and Manly, {Jennifer J.} and Pi-Sunyer, {F. Xavier}",
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T1 - Metformin, lifestyle intervention, and cognition in the diabetes prevention program outcomes study

AU - for the Diabetes Prevention Program Research Group

AU - Luchsinger, José A.

AU - Ma, Yong

AU - Christophi, Costas A.

AU - Florez, Hermes J

AU - Golden, Sherita H.

AU - Hazuda, Helen

AU - Crandall, Jill

AU - Venditti, Elizabeth

AU - Watson, Karol

AU - Jeffries, Susan

AU - Manly, Jennifer J.

AU - Pi-Sunyer, F. Xavier

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective: We examined the association of the Diabetes Prevention Program(DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. Research Design and Methods: The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. Results: A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 6 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ϵ4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) andmetformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. Conclusions: Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.

AB - Objective: We examined the association of the Diabetes Prevention Program(DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. Research Design and Methods: The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. Results: A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 6 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ϵ4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) andmetformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. Conclusions: Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.

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