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Cognitive impairment is common in patients with type 2 diabetes mellitus (T2DM) and negatively impacts effective diabetes self-care. However, it is unclear whether self-care level can predict cognition status in T2DM patients. We aimed to identify self-care scores that would provide information on the patients’ cognition status. Methods: We collected diabetes self-care and cognition data from 50 T2DM patients (age 55.9±7.6 years, diabetes duration 10.1±8.2 years, A1C 7.1±1.4%, 54% female) using the Scale for Summary of Diabetes Self-Care Activities Assessment (SDSCA) and the Montreal Cognitive Assessment (MoCA) . A mixed effects logistic regression model for repeated measures used both baseline and 6 months follow-up observations with adjustment for within-subject correlation (SAS GLMMIX) . First, from nine potential covariates, an iterative backward elimination process selected a parsimonious subset of covariates for predicting MoCA level (normal vs. impairment) , optimizing area under the curve (AUC) . Four covariates were identified (education, income, ethnicity, sleep quality; AUC=.75) . Then an iterative process calculated AUC for MoCA level predicted from self-care level, using each possible self-care score cut point from .to 6.95 in .increments, controlling for the four identified covariates. An optimal cut point was selected that produced the highest AUC value. Results: The optimal self-care cut point was 2.95 (AUC=.76) , producing good discrimination of MoCA level. As a sensitivity analysis, the second best cut point of 3.95 produced AUC=.75. Conclusion: Self-care cut points, accounting for education, income, ethnicity, and sleep quality, could be used to gain information on T2DM patients’ cognition status, which may prompt clinicians and researchers to further evaluation with formal cognitive tests. Disclosure S.E.Choi: None. M.Freeby: Research Support; Abbott Diabetes, Novo Nordisk. B.Roy: None. M.A.Woo: None. R.Kumar: None. M.Brecht: None. Funding National Institutes of Health (RNR017190)

Introduction: Patients with type 2 diabetes mellitus (T2DM) show variable brain tissue changes and mood and cognitive symptoms, which may result from altered cerebral blood flow (CBF). However, the regional CBF status in controlled and uncontrolled T2DM patients remains unclear, which can be examined with arterial spin labeling (ASL) imaging. Our aim was to examine regional CBF between controlled and uncontrolled T2DM patients using ASL imaging procedures. Methods: We collected hemoglobin A1c (A1C) data and 3D pseudo-continuous ASL data from 32 T2DM patients (16 controlled [A1C < 7%], age, 56.5±6.5 years; BMI, 29.6±6.2 kg/m2; 8 female; 16 uncontrolled [A1C ≥ 7%], age, 57.6±7.5 years; BMI, 30.0±5.1 kg/m2; 11 female) using a 3.0-Tesla MRI. A1C was measured by point-of-care testing. Whole-brain CBF maps were calculated, normalized to a common space, smoothed, and compared between groups (controlled T2DM patients vs. uncontrolled T2DM patients) using analysis of covariance (SPM12; covariates, age and sex; p Results: No significant differences in age or sex appeared between groups. Multiple brain areas showed decreased CBF values in the cingulate, caudate, putamen, insula, hippocampus, amygdala, thalamus, hypothalamus, midbrain, cerebellum, prefrontal and frontal, and temporal cortices in uncontrolled T2DM patients over controlled T2DM patients. However, few brain sites in controlled T2DM patients, including the cerebellum, pons, medulla, parahippocampal gyrus, and temporal cortices showed reduced CBF over uncontrolled T2DM patients. Conclusion: Uncontrolled T2DM patients show significant reduction in CBF compared to controlled T2DM in areas that are involved in mood and cognition regulation. The findings suggest that uncontrolled levels may contribute to reduce regional CBF leading to site-specific tissue changes resulting to mood and cognition deficits in the condition. Disclosure S. E. Choi: None. B. Roy: None. M. Freeby: Research Support; Self; Abbott Diabetes, Novo Nordisk Inc. R. Kumar: None. Funding National Institutes of Health (1R01NR017190-03, 3R01NR017190-03S1)

Patients with type 2 diabetes mellitus (T2DM) show brain tissue changes in mood and cognitive control sites. However, it is unclear whether brain microstructural tissue changes differ between patients with controlled (hemoglobin A1c [A1C] Results: No significant differences appeared between groups in age or sex. Mean duration of diabetes was significantly different between controlled and uncontrolled T2DM patients (p Conclusion: Uncontrolled T2DM patients show widespread chronic brain microstructural changes in areas that are involved in mood and cognition regulation. The findings support tight glycemic control to prevent further brain tissue damages in patients with T2DM. Disclosure S.E. Choi: None. B. Roy: None. M. Freeby: Research Support; Self; Abbott, Novo Nordisk Inc. M.A. Woo: None. R. Kumar: None. Funding National Institutes of Health (R01NR017190)

Background: Adults with type 2 diabetes mellitus (T2DM) frequently report poor sleep quality. However, the impact of poor sleep, which may exacerbate brain changes in T2DM patients, is unclear. Study aim was to evaluate sleep symptoms and the relationship between sleep quality and brain changes in T2DM using high-resolution magnetic resonance imaging (MRI) procedures. Methods: Brain MRI images were collected from 17 T2DM patients (age 55.8 ± 7.0 years, 7 males) and 52 controls (age 55.7 ± 1.8 years, 32 males) using a 3.0-Tesla MRI scanner. Sleep symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI) and images evaluated using gray matter density (GMD) maps. Statistical analysis included partial correlations and ANCOVA (covariates: age, sex). Results: T2DM patients showed worse sleep symptoms compared to controls (7.2 ± 4.0 vs. 3.6 ± 2.0; p Conclusion: Adults with T2DM show reduced GMD negatively correlating with increased sleep disturbance symptoms. Potential mechanisms are unclear, but may involve altered glucose metabolism or hypoxic-induced processes. Efforts to improve sleep quality may help mitigate brain changes in T2DM patients. Disclosure C. Cabrera-Mino: None. B. Roy: None. M.A. Woo: None. R. Kumar: None. S.E. Choi: None. Funding National Institute of Nursing Research (1R01NR017190-01A1)

Cognitive impairments are common in patients with type 2 diabetes (T2DM) and adversely impact self-care and glycemic control. However, brain injury in a site that controls cognition (prefrontal cortices; PFC) and its relationship to glycemic outcomes in T2DM remains unclear. Methods: We examined 9 T2DM patients (age 58.2 ± 4.6 years; BMI 30.3 ± 5.0 kg/m2;3 males) and 47 healthy controls (age 55.7 ± 4.2 years; BMI 26.4 ± 3.0 kg/m2; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [A1C]), and PFC status via brain magnetic resonance imaging (MRI). Two high-resolution T1-weighted images were collected using a 3.0-Tesla MRI scanner to evaluate PFC status with voxel-based morphometry (VBM) procedures. Results: No significant differences in age and gender emerged between T2DM and control subjects. However, BMI values were significantly higher in T2DM subjects over controls. MoCA scores were significantly lower in T2DM patients compared to controls (24.3 ± 2.4 vs. 26.9 ± 2.3; p = 0.004). Mean A1C was 7.6±0.8% (51-68 mmol/mol) in T2DM patients. Reduced PFC volume was observed in T2DM patients compared to controls (left 0.35±0.02 vs. 0.41±0.03, p Conclusions: T2DM patients have PFC brain damage which is associated with cognitive deficits and poor glycemic control. Further research is needed to identify causal relationships between A1C and brain changes in T2DM and to examine interventions to enhance brain/neurogenesis and its impact on A1C. Disclosure S.E. Choi: None. B. Roy: None. R. Kumar: None. M. Freeby: None. R.S. Mullur: None. M.A. Woo: None. Funding National Institutes of Health (R01NR017190)