1. Bri Bronsky, Cristin Adams, and Corinne McGill
The Link Between Poorly Controlled Type II Diabetes and Alzheimer’s Disease
Bri Bronsky, Cristin Adams, and Corinne McGill

2. Poorly Controlled Type 2 Diabetes = Risk of Alzheimer’s Disease
Study Question
Does poorly controlled type 2 diabetes increase the risk of developing Alzheimer’s disease in adults aged compared to those with controlled diabetes?
Hypothesis
H0: Rexp= Runexp
HA: Rexp> Runexp
Poorly Controlled Type 2 Diabetes = Risk of Alzheimer’s Disease

3. Exposure Outcome Uncontrolled Diabetes (A1C > 9 )
Clinical Diagnosis of Alzheimer’s Disease

4. Study Design - Prospective Cohort
Diabetic
Positron emission tomography (PET)

5. Data Analysis Main exposure: uncontrolled or controlled DM
Dichotomous variable
Primary outcome: diagnosis of AD or no diagnosis of AD
Measure of association: risk ratio
Runcontrolled DM/ Rcontrolled DM
Covariates
Hypertension, hyperlipidemia, obesity, family history of AD
Sample size estimate: 47,180 individuals (see next slide)

6. From https://www.openepi.com/SampleSize/SSCohort.htm

7. Problems, Pitfalls, Limitations
High cost given numbers and proposed testing
Large number of people required given relatively low incidence AD
Variable blood sugar control over time
Medication differences
Patients inevitably lost to follow up
Those with dementia may be more likely to be lost to follow up
Bias is toward the null

8. References
American Diabetes Association. (2018, March 22). Diabetes Statistics about Diabetes.
Keene, C.D., Montine, T.J., Kuller, A.H. (2018). Epidemiology, pathology, and pathogenesis of Alzheimer disease. Wilterdink, J.L. (Ed.), UpToDate. Retrieved October 29, 2018, from
A1C test. (2018, April 05). Retrieved from
Weintraub S, Salmon D, Mercado N, … Morris JC. (2009). The Alzheimer’s disease centers’ Uniform Data
Set (UDS): The Neuropsychologic Test Battery. Alzheimer Dis Assoc Disord, 23(2),
Hachinski V, Iadecola C, Petersen RC, … Leblanc GG. (2006). National Institute of Neurological Disorders
and Stroke-Canadian Stroke Network Vascular Cognitive Impairment harmonization standards. Stroke, 37,