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Super-Tight Blood Sugar Control May Not Ease Mental Decline in Diabetics
Date:9/28/2011

searchers assigned 2,977 with type 2 diabetes at high risk for heart disease to intensive blood-sugar lowering or current treatment. The participants were 55 to 80 years old. Intensive blood sugar lowering meant reducing blood sugar to less than 6 percent as measured by an A1c test. The current standard is to maintain blood sugar at between 7 and 7.5 percent.

Some patients (614) also had an MRI to measure brain volume and took cognitive ability tests at the beginning and end of the study.

After about 39 months, no difference in cognitive ability existed between the groups, the researchers found. However, patients in the intensive care group had a significantly larger brain volume than patients in the standard treatment group.

But, the larger brain volume didn't translate to better thinking abilities.

The part of the ACCORD trial involving intensive lowering of blood sugar was halted earlier than planned. An increased risk of death, the finding of no overall benefit on cardiovascular disease, problems caused by too-low blood sugar and weight gain were all factors in stopping.

Dr. Geert Jan Biessels, a neurologist at the Rudolf Magnus Institute of Neuroscience at the University Medical Center in Utrecht, the Netherlands, wrote a journal editorial accompanying the study. He said that "dementia is the most important cognitive complication of diabetes. The present study assessed the effects of treatment on average cognitive functioning across the whole study population. It is uncertain, however, if average cognitive functioning is an adequate proxy for dementia."

On average, cognition was not improved, he said. "However, the absence of an effect of treatment on mean cognitive functioning cannot yet be regarded as proof that the treatment may not delay dementia," he said. "But, at present the results do not support specific treatments to prevent cognitive decline in diabetes."

Another expert, Dr. Jay Skyler, a professor of
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