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4 Associations Between Glycemia and Cognitive Performance in Adults with Type 1 Diabetes (T1D) using Continuous Glucose Monitoring (CGM) and Ecological Momentary Assessment (EMA)
- Olivia H Wang, Miranda Zuniga-Kennedy, Luciana Mascarenhas Fonseca, Michael Cleveland, Zoe W. Hawks, Lanee Jung, Jane D. Bulger, Elizabeth Grinspoon, Shifali Singh, Martin Sliwinski, Alandra Verdejo, Ruth S. Weinstock, Laura Germine, Naomi Chaytor
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 792-793
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- Article
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Objective:
Despite associations between hypoglycemia and cognitive performance using cross-sectional and experimental methods (e.g., Insulin clamp studies), few studies have evaluated this relationship in a naturalistic setting. This pilot study utilizes an EMA study design in adults with T1D to examine the impact of hypoglycemia and hyperglycemia, measured using CGM, on cognitive performance, measured via ambulatory assessment.
Participants and Methods:Twenty adults with T1D (mean age 38.9 years, range 26-67; 55% female; 55% bachelor’s degree or higher; mean HbA1c = 8.3%, range 5.4% - 12.5%), were recruited from the Joslin Diabetes Center at SUNY Upstate Medical University. A blinded Dexcom G6 CGM was worn during everyday activities while completing 3-6 daily EMAs using personal smartphones. EMAs were delivered between 9 am and 9 pm, for 15 days. EMAs included 3 brief cognitive tests developed by testmybrain.org and validated for brief mobile administration (Gradual Onset CPT d-prime, Digit Symbol Matching median reaction time, Multiple Object Tracking percent accuracy) and self-reported momentary negative affect. Day-level average scores were calculated for the cognitive and negative affect measures. Hypoglycemia and hyperglycemia were defined as the percentage of time spent with a sensor glucose value <70 mg/dL or > 180 mg/dL, respectively. Daytime (8 am to 9 pm) and nighttime (9 pm to 8 am) glycemic excursions were calculated separately. Multilevel models estimated the between- and within-person association between the night prior to, or the same day, time spent in hypoglycemia or hyperglycemia and cognitive performance (each cognitive test was modeled separately). To evaluate the effect of between-person differences, person-level variables were calculated as the mean across the study and grand-mean centered. To evaluate the effect of within-person fluctuations, day-level variables were calculated as deviations from these person-level means.
Results:Within-person fluctuations in nighttime hypoglycemia were associated with daytime processing speed. Specifically, participants who spent a higher percentage of time in hypoglycemia than their average percentage the night prior to assessment performed slower than their average performance on the processing speed test (Digit Symbol Matching median reaction time, b = 94.16, p = 0.042), while same day variation in hypoglycemia was not associated with variation in Digit Symbol Matching performance. This association remained significant (b = 97.46, p = 0.037) after controlling for within-person and between-person effects of negative affect. There were no significant within-person associations between time spent in hyperglycemia and Digit Symbol Matching, nor day/night hypoglycemia or hyperglycemia and Gradual Onset CPT or Multiple Object Tracking.
Conclusions:Our findings from this EMA study suggest that when individuals with T1D experience more time in hypoglycemia at night (compared to their average), they have slower processing speed the following day, while same day hypoglycemia and hyperglycemia does not similarly impact processing speed performance. These results showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive variation in real world settings that have direct clinical applications for optimizing cognitive performance. Future research with larger samples is needed to replicate these findings.
Contributors
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- By Douglas L. Arnold, Laura J. Balcer, Amit Bar-Or, Sergio E. Baranzini, Frederik Barkhof, Robert A. Bermel, Francois A. Bethoux, Dennis N. Bourdette, Richard K. Burt, Peter A. Calabresi, Zografos Caramanos, Tanuja Chitnis, Stacey S. Cofield, Jeffrey A. Cohen, Nadine Cohen, Alasdair J. Coles, Devon Conway, Stuart D. Cook, Gary R. Cutter, Peter J. Darlington, Ann Dodds-Frerichs, Ranjan Dutta, Gilles Edan, Michelle Fabian, Franz Fazekas, Massimo Filippi, Elizabeth Fisher, Paulo Fontoura, Corey C. Ford, Robert J. Fox, Natasha Frost, Alex Z. Fu, Siegrid Fuchs, Kazuo Fujihara, Kristin M. Galetta, Jeroen J.G. Geurts, Gavin Giovannoni, Nada Gligorov, Ralf Gold, Andrew D. Goodman, Myla D. Goldman, Jenny Guerre, Stephen L. Hauser, Peter B. Imrey, Douglas R. Jeffery, Stephen E. Jones, Adam I. Kaplin, Michael W. Kattan, B. Mark Keegan, Kyle C. Kern, Zhaleh Khaleeli, Samia J. Khoury, Joep Killestein, Soo Hyun Kim, R. Philip Kinkel, Stephen C. Krieger, Lauren B. Krupp, Emmanuelle Le Page, David Leppert, Scott Litwiller, Fred D. Lublin, Henry F. McFarland, Joseph C. McGowan, Don Mahad, Jahangir Maleki, Ruth Ann Marrie, Paul M. Matthews, Francesca Milanetti, Aaron E. Miller, Deborah M. Miller, Xavier Montalban, Charity J. Morgan, Ichiro Nakashima, Sridar Narayanan, Avindra Nath, Paul W. O’Connor, Jorge R. Oksenberg, A. John Petkau, Michael D. Phillips, J. Theodore Phillips, Tammy Phinney, Sean J. Pittock, Sarah M. Planchon, Chris H. Polman, Alexander Rae-Grant, Stephen M. Rao, Stephen C. Reingold, Maria A. Rocca, Richard A. Rudick, Amber R. Salter, Paula Sandler, Jaume Sastre-Garriga, John R. Scagnelli, Dana J. Serafin, Lynne Shinto, Nancy L. Sicotte, Jack H. Simon, Per Soelberg Sørensen, Ryan E. Stagg, James M. Stankiewicz, Lael A. Stone, Amy Sullivan, Matthew Sutliff, Jessica Szpak, Alan J. Thompson, Bruce D. Trapp, Helen Tremlett, Maria Trojano, Orla Tuohy, Rhonda R. Voskuhl, Marc K. Walton, Mike P. Wattjes, Emmanuelle Waubant, Martin S. Weber, Howard L Weiner, Brian G. Weinshenker, Bianca Weinstock-Guttman, Jeffrey L. Winters, Jerry S. Wolinsky, Vijayshree Yadav, E. Ann Yeh, Scott S. Zamvil
- Edited by Jeffrey A. Cohen, Richard A. Rudick
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- Book:
- Multiple Sclerosis Therapeutics
- Published online:
- 05 December 2011
- Print publication:
- 20 October 2011, pp viii-xii
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6 - e-Health challenges and opportunities
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- By Steven Shea, Professor of Medicine and Epidemiology (in Biomedical Informatics) and Chief, Division of General Medicine Columbia University, Justin Starren, Assistant Professor of Biomedical Informatics and Radiology Columbia University, College of Physicians and Surgeons, Ruth S. Weinstock, Professor of Medicine and Chief, Endrocrinology, Diabetes and Metabolism SUNY Upstate Medical University and Department of Veterans Affairs Medical Center at Syracuse, Alice Lee, Vice President of Clinical Systems CareGroup HealthCare System, David Delaney, Technical Director, Web Applications CareGroup HealthCare System, Jim Brophy, PatientSite Project Leader CareGroup HealthCare System, John Glaser, Vice President and Chief Information Officer Partners HealthCare System, Cynthia Bero, Chief Information Officer Partners Community HealthCare Inc.
- Edited by Don Detmer, University of Virginia, Elaine Steen, University of Virginia
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- Book:
- The Academic Health Center
- Published online:
- 12 November 2009
- Print publication:
- 12 May 2005, pp 240-278
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Summary
Introduction
The advent of the Internet has been almost universally heralded. It has been compared to most of the important technological milestones in human history, from the capture of fire to the development of electricity, the steam engine, and the telephone. The Internet's dynamic, even explosive, growth is often described using biological metaphors (e.g., “a squirming, protoplasmic nexus of informational activity”) that suggest the development of a nascent hypertrophic organism of uncertain but highly promising ontogeny (Valovic, 2000, p. 24).
Indeed, the Internet, as a technology platform, is having a significant, even revolutionary, impact on communications, on the flow of and access to information, on the speed and efficiency of many types of transactions, and on connectivity between and among an ever-growing mass of electronically networked individuals, organizations, and systems. It is affecting everything from the behavior of individuals to the conduct of commerce. “The Net” has spawned whole industries and transformed others. It has created new categories of jobs and career paths, while making others obsolete. It has affected many aspects of our culture, from language, to customs, to the meaning of symbols. Its ubiquity crosses national borders and political boundaries. It has created untold thousands of virtual or cyber communities and has forever transformed many real communities. It sparked “irrationally exuberant” activity in the nation's stock market, catalyzing the creation (and then subsequently destruction) of new wealth.
Novel applications of Internet-based technologies are found or created almost daily.