ArticleBMJ open2026
Association of diabetes severity with cognitive function in US adults: a cross-sectional analysis of the AI-READI multicentre cohort.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate whether type 2 diabetes mellitus (T2DM) presence and severity are associated with differences in global and domain-specific cognitive function among US adults, using standardised Montreal Cognitive Assessment (MoCA) testing.
designCross-sectional study
settingThree U.S academic medical centres participating in the Artificial Intelligence-Ready and Equitable Atlas for Diabetes Insights (AI-READI) study.
participantsAdults aged ≥40 years enrolled in the AI-READI cross-sectional study at three US academic medical centres were eligible. The study excluded individuals with type 1 diabetes, pregnancy or inability to speak, read and understand English. For this secondary analysis, 1067 participants from the first publicly released AI-READI data set who had MoCA data and assigned glycaemic status were included. Participants were classified into four prespecified glycaemic groups: controls without diabetes (n=371), pre-diabetes (n=239), medication-controlled type 2 diabetes (n=323), and insulin-dependent type 2 diabetes (n=129). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was global cognitive function measured by the MoCA total score. Secondary outcomes included MoCA domain scores and the prevalence of cognitive impairment, defined as MoCA<26.
resultsSignificant differences in MoCA total scores were observed across glycaemic groups (p<0.001), with the lowest mean score (24.0) among insulin-dependent individuals and highest among controls (25.8), and the significant difference remained in multivariable analyses (p=0.02). Among MoCA subdomains, mean abstraction scores were significantly lower (1.76) in insulin-dependent T2DM group than other glycaemic groups (mean score 1.87-1.89) in multivariable analysis (p=0.03). The prevalence of cognitive impairment increased from 39% in controls to 58% in the insulin-dependent group. In multivariable analysis, increasing diabetes severity was associated with higher risk of cognitive impairment with adjusted OR 1.85 (95% CI: 1.11 to 3.07) for insulin-dependent T2DM and 1.50 (95% CI: 1.05 to 2.15) for medication-controlled T2DM.
conclusionsIndividuals with more advanced T2DM, particularly those on insulin, had significantly higher risk of cognitive impairment. These findings support routine cognitive screening in patients with T2DM, especially those on insulin therapy. Early identification of cognitive impairment may improve diabetes management and cognitive outcomes.
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