Project 446721

The discovery of insulin was an outstanding life saving achievement. However, it transformed diabetes into a chronic disease causing numerous complications. Important advances in the prevention of these complications have been achieved, prolonging life in patients with type 2 diabetes (T2D). In doing so, a new serious complication of diabetes, dementia, has emerged. Accelerated cognitive decline occurs in patients with T2D and is believed to be due to poor blood glucose control. However, the interplay and roles of high glucose versus age-related brain disorders in such decline remains unclear. The overall goal of this research is to find out what predicts cognitive decline in patients with T2D showing the early stage of mild cognitive impairment (MCI). Our main hypothesis is that the presence of Alzheimer's or cerebrovascular disease together with poor blood glucose control are the main drivers of cognitive decline in T2D patients. We propose to evaluate in detail (e.g. cognitive testing, unique blood tests, imaging, continuous glucose monitoring) 250 patients 60-85 years old with T2D and MCI. We will follow these patients for 3 years and reassess their cognitive function at the end. This will allow us to determine which patient characteristics at the beginning predicted subsequent loss of cognitive function. We anticipate findings that will help uncover new therapies for cognitive dysfunction in T2D. Application of such treatments to those with MCI and at high risk of progression could prevent dementia-the severe form of cognitive dysfunction which impairs quality of life and leads to institutional care. This would replicate the strategy and success - longer healthy lifespan - achieved for the classical complications of diabetes. This project brings together a unique team of research doctors, scientists, patients and community users. It is led by researchers at McGill University and Western University, which have much experience in diabetes and brain research.