Accelerated cognitive decline risk with diabetes higher in women than men

Among patients with type 2 diabetes (T2D), women appear to be at greater risk of accelerated cognitive decline than men, as reported in a study. This risk increase can be partly explained by depressive symptoms being greater among women.

The analysis included 1,203 (38 percent) women and 1,960 (62 percent) men with T2D who participated in the cognition substudy of CAROLINA. The mean age of the entire population was 64.4 years, and the mean T2D duration was 7.6 years.

Age, diabetes duration, and glycaemic control were similar in the two groups, but there were sex-specific differences in race (White: 80.9 percent female vs 86.8 percent male; Black/African American: 8.8 percent vs 4.1 percent, respectively) and having ≥12 years of formal education (19.9 percent vs 26.2 percent, respectively).

Compared with men, women had a higher body mass index (31.4 vs 30.4 kg/m²), smaller waist circumference (102.2 vs 106.9 cm), lower diastolic blood pressure (78.0 vs 79.2 mm Hg), and higher low-density (2.5 vs 2.3 mmol/L) and high-density (1.4 vs 1.2 mmol/L) lipoprotein cholesterol. Meanwhile, men were more likely to be current smokers (19.4 percent vs 15.6 percent) and had significantly more macrovascular complications overall (37.4 percent vs 21.6 percent).

Over a median follow-up of 6.1 years, a greater proportion of women than men exhibited accelerated cognitive decline (30 percent vs 25.2 percent; odds ratio [OR], 1.27, 95 percent confidence interval [CI], 1.08–1.49; p=0.003). Compared with men, women showed larger declines over time on Mini-Mental State Examination (–0.5 vs –0.3 points) and Trail Making Test A (4.8 vs 3.3 seconds).

Depressive symptoms were more prevalent in women (24.3 percent vs 12.5 percent) and mediated the relationship between sex and accelerated cognitive decline (mediation effect 20.3 percent; p=0.03). No other significant mediators were identified.