Fluid Cognition Reduced Among Patients With Youth-Onset Type 2 Diabetes

A team of investigators assessed cognitive performance among adolescents and young adults with type 1 or type 2 diabetes.

Youth-onset type 2 diabetes (T2D) was found to be associated with poorer fluid cognition compared with youth-onset type 1 diabetes (T1D), according to data from the SEARCH for Diabetes in Youth Study published in Diabetes Care.

Patients (N=1673) aged younger than 20 years were recruited for this US population-based registry beginning in 2002.  They were followed up approximately 10 to almost 20 years later, and cognition was assessed using the National Institutes of Health Toolbox Cognition Battery (NIHT-CB).

At follow-up, the mean age of participants was 21.6 years. They had been diagnosed with diabetes an average of 11.0 years previously, and most had T1D (n=1095). All cohort characteristics differed significantly on the basis of T1D or T2D status (all P £.01), except for mean glycated hemoglobin (P =.83).

During NIHT-CB assessment, average scores were significantly lower among the T2D cohort for composite fluid cognition (84.7±17.1 vs 95.5±16.7; P <.001), pattern comparison processing speed (92.8±20.5 vs 100.4±21.0; P <.001), Flanker inhibitory control and attention (79.2±13.1 vs 84.7±12.8; P <.001), list sorting working memory (91.2±15.1 vs 100.1±13.8; P <.001), picture sequence memory (95.7±15.7 vs 102.7±16.8; P <.001), dimensional change card sort (90.3±17.5 vs 98.0±16.8; P <.001), and picture vocabulary (91.5±14.1 vs 103.6±15.0; P <.001).

In the fully adjusted model, composite fluid cognition outcomes were positively associated with increased picture vocabulary score (b, 0.41; 95% CI, 0.35-0.48; P <.0001) and female sex (b, 1.81; 95% CI, 0.07-3.54; P =.04) and negatively correlated with increased Center for Epidemiologic Studies-Depression score (b, -0.20; 95% CI, -0.30 to -0.10; P <.0001) and waist-to-height ratio (b, -1.50; 95% CI, -2.59 to -0.41; P <.01).

This study was limited by not including data on functional difficulties or academic performance. It therefore remains unclear whether the differences observed in fluid cognition would have a real-world impact on individuals with youth-onset T2D.


Shapiro ALB, Dabelea D, Stafford JM, et al; for the SEARCH for Diabetes in Youth Study Group. Cognitive function in adolescents and young adults with youth-onset type 1 versus type 2 diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2021;44:1-9. doi:10.2337/dc20-2308