Link between Diabetic Treatment Modalities (Oral medication, Insulin) and Global Cognitive Functioning Among Mexican Americans: An HABLE Study

Background: Diabetes is a significant health concern for the Hispanic population as diagnosis occurs, on average 10 years earlier than among non-Hispanic Whites and at a higher frequency. The link between diabetes and cognitive impairment has been supported though this link is not well understood. Recent empirical findings have suggested the use of insulin as a potential means for improving cognitive functioning; however, only one study to date has examined the implications of diabetes medication treatment on cognitive functioning among a sample of non-Hispanic whites. The aim of this study was to examine the implications of diabetes treatment modalities (oral medication, insulin) on cognitive functioning among a sample of Hispanic adults and elders. Methods: Data was analyzed from 201 Hispanic Mexican American participants with a diagnosis of diabetes and who endorsed diabetic treatment (oral medication n=172; insulin n=54) from the Health and Aging Brain Study among Latino Elders (HABLE). Each participant underwent an interview (i.e. medical history, medications, and health behaviors), neuropsychological testing, blood draw, medical examination, and informant interviews. Diagnosis of MCI was assigned according to published criteria and was designated based on weekly consensus reviews. Global cognitive functioning was assessed utilizing the Mini Mental Status Examination (MMSE). HbA1c levels were categorized based on diabetic control status with values below 8% being considered controlled. Liner regressions were utilized with the dependent variable being global cognitive functioning and the independent variable being diabetic treatment modality. Age, gender and education were entered into the models as covariates. Results: Among the total sample, use of oral medication as a treatment for diabetes was associated with higher global cognitive functioning (B[SE] = 1.43[0.66], t-test=2.14, p-value = 0.033). When split by diabetic control status, those with uncontrolled diabetes (HbA1c level ≥ 8) and who were taking oral medications also demonstrated higher global cognitive functioning as measured by the MMSE (B[SE]= 2.28 [0.76], t-test=3.03, p-value = 0.003). Insulin treatment was not found to be significantly associated with global cognitive functioning within the total sample or when split by diabetic control status. Conclusions: The results of our study suggest that diabetic treatment modalities differentially impact cognitive functioning among a sample of Hispanic Mexican Americans with oral medication showing to be significantly impactful. Future studies should further examine the link between specific oral diabetic medications and cognitive functioning.