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EDITORIALS: Mark W J Strachan, Jacqueline F Price, and Brian M Frier Diabetes, cognitive impairment, and dementia BMJ 2008; 336: 6 [Full text]

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Diabetes, cognitive impairment and dementia - the potential role of PPG

Jiten Dave, Lakhveer Sahota   (23 January 2008)

Diabetes, cognitive impairment and dementia - the potential role of PPG 23 January 2008
Jiten Dave, Pharmaceutical Physician Daichi-Sankyo UK, Bucks, Lakhveer Sahota Send response to journal: Re: Diabetes, cognitive impairment and dementia - the potential role of PPG	Dear Sir, Re: Diabetes, Cognitive Impairment and Dementia BMJ Editorial 2008; 336:6 (5 January) This excellent Editorial briefly reviewed the data linking diabetes, cognitive impairment and dementia and explored the challenges in delineating the underlying contributory mechanisms. Whilst the authors mentioned that ‘shorter term changes in blood glucose concentrations may also affect cognitive function in people with diabetes’ a notable omission was the potential relationship of postprandial plasma glucose (PPG) and cognitive functioning in elderly Type 2 diabetic patients. Abbatecola et al (Postprandial plasma glucose (PPG) excursions and cognitive functioning in aged type 2 diabetics. Neurology July 2006, 67; 235-240) in a year long academically funded study, compared repaglinide with glibenclamide and prospectively confirmed the hypothesis that an elevated PPG instability may be associated with cognitive functioning. Repaglinide and glibenclamide both showed a significant decline in haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) . However only, repaglinide administration was associated with a significant lowering of PPG. After adjusting for HbA1c and coefficient of variation of PPG, a decline in cognitive function was only seen in the glibenclamide group. The authors conclude that tighter control of PPG excursions may prevent cognitive decline in older diabetic individuals.Hopefully, the planned prospective studies studying the relation between type 2 diabetes and cognitive impairment further explore the specific role of PPG and agents that specifically target this risk factor. Dr Jiten Dave MBBS MRCGP MFPM Independent Pharmaceutical Physician Competing interests: consultancy work for various companies including Daichi Sankyo. Lak Sahota BPharm MRPharmS DipPIM Medical Services Director Daiichi Sankyo UK Ltd Competing interests: Consultancy work for Daichi Sankyo UK