Metformin Use and Cognitive Function in Older Adults With Type 2 Diabetes Following a Mediterranean Diet Intervention
Por:
Soldevila-Domenech, N, Cuenca-Royo, A, Babio, N, Forcano, L, Nishi, S, Vintro-Alcaraz, C, Gomez-Martinez, C, Jimenez-Murcia, S, Fernandez-Carrion, R, Gomis-Gonzalez, M, Alvarez-Sala, A, Carlos, S, Pinto, X, Corella, D, Diez-Espino, J, Castaner, O, Fernandez-Aranda, F, Salas-Salvado, J and de la Torre, R
Publicada:
5 oct 2021
Resumen:
Background and Purpose: Both adherence to the Mediterranean diet (MedDiet) and the use of metformin could benefit the cognitive performance of individuals with type 2 diabetes, but evidence is still controversial. We examined the association between metformin use and cognition in older adults with type 2 diabetes following a MedDiet intervention.
Methods: Prospective cohort study framed in the PREDIMED-Plus-Cognition sub-study. The PREDIMED-Plus clinical trial aims to compare the cardiovascular effect of two MedDiet interventions, with and without energy restriction, in individuals with overweight/obesity and metabolic syndrome. The present sub-study included 487 cognitively normal subjects (50.5% women, mean +/- SD age of 65.2 +/- 4.7 years), 30.4% of them (N = 148) with type 2 diabetes. A comprehensive battery of neurocognitive tests was administered at baseline and after 1 and 3 years. Individuals with type 2 diabetes that exhibited a good glycemic control trajectory, either using or not using metformin, were compared to one another and to individuals without diabetes using mixed-effects models with inverse probability of treatment weights.
Results: Most subjects with type 2 diabetes (83.1%) presented a good and stable glycemic control trajectory. Before engaging in the MedDiet intervention, subjects using metformin scored higher in executive functions (Cohen's d = 0.51), memory (Cohen's d = 0.38) and global cognition (Cohen's d = 0.48) than those not using metformin. However, these differences were not sustained during the 3 years of follow-up, as individuals not using metformin experienced greater improvements in memory (beta = 0.38 vs. beta = 0.10, P = 0.036), executive functions (beta = 0.36 vs. beta = 0.02, P = 0.005) and global cognition (beta = 0.29 vs. beta = -0.02, P = 0.001) that combined with a higher MedDiet adherence (12.6 vs. 11.5 points, P = 0.031). Finally, subjects without diabetes presented greater improvements in memory than subjects with diabetes irrespective of their exposure to metformin (beta = 0.55 vs. beta = 0.10, P < 0.001). However, subjects with diabetes not using metformin, compared to subjects without diabetes, presented greater improvements in executive functions (beta = 0.33 vs. beta = 0.08, P = 0.032) and displayed a higher MedDiet adherence (12.6 points vs. 11.6 points, P = 0.046).
Conclusions: Although both metformin and MedDiet interventions are good candidates for future cognitive decline preventive studies, a higher adherence to the MedDiet could even outweigh the potential neuroprotective effects of metformin in subjects with diabetes.
Filiaciones:
Soldevila-Domenech, N:
Hosp Mar Med Res Inst IMIM, Integrat Pharmacol & Syst Neurosci Res Grp, Neurosci Res Program, Barcelona, Spain
Univ Pompeu Fabra, Dept Expt & Hlth Sci, Barcelona, Spain
Cuenca-Royo, A:
Hosp Mar Med Res Inst IMIM, Integrat Pharmacol & Syst Neurosci Res Grp, Neurosci Res Program, Barcelona, Spain
Babio, N:
Univ Rovira & Virgili, Dept Biochem & Biotechnol, Hosp Univ St Joan de Reus, Inst Invest Sanitaries Pere & Virgili,Human Nutr, Reus, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Forcano, L:
Hosp Mar Med Res Inst IMIM, Integrat Pharmacol & Syst Neurosci Res Grp, Neurosci Res Program, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Nishi, S:
Univ Rovira & Virgili, Dept Biochem & Biotechnol, Hosp Univ St Joan de Reus, Inst Invest Sanitaries Pere & Virgili,Human Nutr, Reus, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Vintro-Alcaraz, C:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Hosp Bellvitge, Dept Psychiat, Barcelona, Spain
Inst Invest Biomed Bellvitge IDIBELL, Psychiat & Mental Hlth Grp, Neurosci Program, Barcelona, Spain
Gomez-Martinez, C:
Univ Rovira & Virgili, Dept Biochem & Biotechnol, Hosp Univ St Joan de Reus, Inst Invest Sanitaries Pere & Virgili,Human Nutr, Reus, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Jimenez-Murcia, S:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Hosp Bellvitge, Dept Psychiat, Barcelona, Spain
Inst Invest Biomed Bellvitge IDIBELL, Psychiat & Mental Hlth Grp, Neurosci Program, Barcelona, Spain
Univ Barcelona, Sch Med & Hlth Sci, Dept Clin Sci, Barcelona, Spain
Fernandez-Carrion, R:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Valencia, Sch Med, Dept Prevent Med, Valencia, Spain
Gomis-Gonzalez, M:
Hosp Mar Med Res Inst IMIM, Integrat Pharmacol & Syst Neurosci Res Grp, Neurosci Res Program, Barcelona, Spain
Alvarez-Sala, A:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Valencia, Sch Med, Dept Prevent Med, Valencia, Spain
Carlos, S:
Univ Navarra, Dept Prevent Med & Publ Hlth, Pamplona, Spain
Navarra Hlth Res Inst IDISNA, Pamplona, Spain
Pinto, X:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Hosp Univ Bellvitge, Lipid Unit, Dept Internal Med, Inst Invest Biomed Bellvitge IDIBELL, Barcelona, Spain
Univ Barcelona, Fac Med, Barcelona, Spain
:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Valencia, Sch Med, Dept Prevent Med, Valencia, Spain
Diez-Espino, J:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Navarra, Dept Prevent Med & Publ Hlth, Pamplona, Spain
Navarra Hlth Res Inst IDISNA, Pamplona, Spain
Castaner, O:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Hosp Mar Med Res Inst IMIM, Cardiovasc Risk & Nutr Res Grp, Barcelona, Spain
Hosp Mar Med Res Inst IMIM, Serv Endocrinol, Barcelona, Spain
Fernandez-Aranda, F:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Univ Hosp Bellvitge, Dept Psychiat, Barcelona, Spain
Inst Invest Biomed Bellvitge IDIBELL, Psychiat & Mental Hlth Grp, Neurosci Program, Barcelona, Spain
Univ Barcelona, Sch Med & Hlth Sci, Dept Clin Sci, Barcelona, Spain
Salas-Salvado, J:
Univ Rovira & Virgili, Dept Biochem & Biotechnol, Hosp Univ St Joan de Reus, Inst Invest Sanitaries Pere & Virgili,Human Nutr, Reus, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
de la Torre, R:
Hosp Mar Med Res Inst IMIM, Integrat Pharmacol & Syst Neurosci Res Grp, Neurosci Res Program, Barcelona, Spain
Univ Pompeu Fabra, Dept Expt & Hlth Sci, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Fisiopatol Obesidad &, Madrid, Spain
Green Published, gold
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