O2‐09‐03: Associations Between Glucose Levels and Neuropathological Endpoints Among People Never Treated for Diabetes: the Adult Changes in Thought Study
Year: 2014
Type: article
Study design: Observational Study
Abstract: Project Description: We sought to determine associations between average glucose levels and neuropathological endpoints from a community-based prospective cohort study. The sample was consented decedents with death preceding 10/1/2013 (n=529) excluding those with withdrawn consent (2), no chart review data (19), no continuous Group Health enrollment for 5 years preceding death (25), insufficient laboratory measures to calculate exposure (87), history of treated diabetes (77), or with extremely outlying glucose values (1), leaving n=318. We used clinical HbA1c and glucose measures in a hierarchical Bayesian model to estimate average glucose levels in the five years preceding death. Autopsy protocols included evaluations of the outcomes shown in Table 2. We performed modified Poisson regression analyses to determine associations between average glucose levels and each neuropathological outcome. Our primary models adjusted for study cohort, age at death, sex, and education. In sensitivity analyses we also adjusted for medical comorbidities derived from systematic medical record data abstraction and for APOE genotype. Models also incorporated inverse probability weighting to account for selection to the autopsy cohort, with the bootstrap applied to account for additional uncertainty introduced by estimation of the weights used in the outcome models. We stratified average glucose exposures into <100 mg/dL, 100-110 mg/dL, and >110 mg/dL. Demographic and clinical characteristics are summarized in Table 1, and neuropathological findings are summarized in Table 2. The most interesting unweighted regression findings were for hippocampal sclerosis. Compared to people with average glucose levels < 100 mg/dL, people with average glucose levels 100-110 mg/dL had a relative risk (RR) (95% confidence interval, CI) of 0.50 (0.16-1.51), while people with average glucose levels >110 mg/dL had a RR (95% CI) of 2.24 (0.99-5.06, omnibus p=0.01). Findings were similar in models further adjusting for medical comorbidity and APOE genotype. Point estimates were similar models accounting for selection into the autopsy cohort, but sparse data led to broad confidence intervals when using bootstrapping to account for uncertainty in model-estimated weights. There may be a relationship between average glucose levels and neuropathological processes.
Source: Alzheimer s & Dementia
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2113672162