血糖波动与老年2型糖尿病患者认知功能的关系

目的 探讨血糖波动与老年2型糖尿病患者认知功能的关系.方法 对294例2型糖尿病患者进行3d动态血糖监测,得到反映血糖波动的指标,包括连续48 h的平均血糖水平（mean blood glucose,MBG）及其标准差（standard deviation,SD）、最大血糖波动幅度（largest amplitude of glycemic excursions LAGE）、平均血糖波动幅度（mean amplitude of glycemic excursions,MAGE）和日间血糖平均绝对差（absolute means of daily difference,MODD）,同时对患者进行认知量表的测定,包括简易智力状态量表（the mini-mental state examination,MMSE）,加拿大蒙特利尔认知量表（montreal cognitive assessment,MOCA）,画钟试验（clock drawing test,CDT）,日常生活能力量表（the activities of daily living scale,ADL）,总体衰退量表（global deterioration scale,GDS）.统计分析血糖波动指标与认知量表分数的关系.结果 MMSE分数＜28组的血糖波动参数（MAGE、MODD、SD、MBG）均高于MMSE分数≥28组,两组间的差异具有统计学意义（P＜0.05）,而糖化血红蛋白在两组间差异无统计学意义.MAGE、MODD、LAGE、MBG、SD均与MMSE分数呈负相关（r值波动于-0.161 ～-0.263,P＜0.01）.MAGE、MODD、MBG、SD均与MOCA分数负相关（r值波动于-0.159 ～-0.265,P＜0.05）.校正年龄、受教育程度、糖尿病病程后,MAGE、MODD、MBG、SD与MMSE分数负相关（r值波动于-0.153 ～-0.198,P＜0.05）.MODD、LAGE、MBG、SD均与ADL分数正相关（r值波动于0.128～0.219,P＜0.05）.MAGE、MODD、MBG均与GDS分数正相关（r值波动于0.138 ～0.170,P＜0.05）.MAGE、MODD、LAGE、MBG、SD均与CDT分数负相关（r值波动于-0.134 ～-0.205,P＜0.05）.以MMSE分数为因变量,多元逐步回归分析提示文化程度、MAGE、SD是影响MMSE分数的因素.结论 老年2型糖尿病患者的血糖波动对认知功能有影响,血糖波动幅度较大的患者总体认知功能及执行功能均减退.

Relationship between glycemic excursions and cognitive performance in aged type 2 diabetic patients

Objective To investigate the relationship between blood glucose fluctuations and cognitive status in elder patients with type 2 diabetes. Methods 294 elder patients with type 2 diabetes underwent 72 h dynamic blood glucose monitoring using continuous glucose monitoring system. Glucose variability were obtained including mean blood glucose （MBG） and its standard deviation （SD）, the largest amplitude of glycemic excursions （LAGE）, mean amplitude of glycemic excursions （MAGE） and absolute means of daily difference （MODD）. All subjects were evaluated using a series of cognitive function tests, including the mini-mental status examination （MMSE）, Montreal cognitive assessment （MOCA）, global deterioration scale （GDS）, the activities of daily living scale （ADL）, and clock drawing test （CDT）. The relationship between the blood glucose variability and cognitive performance was assessed. Results The subjects were divided into two groups according to MMSE score. The levels of MAGE, MODD, SD, LAGE and MBG were higher in the group of MMSE score below 28 than those of over 28, and the differences were significant （P 〈 0.01）, while HbA 1 c has no difference between the two groups. MAGE, MODD, LAGE, MBG and SD were significantly reversely correlated with MMSE score （r=-0.161～-0.263, P〈0.01）, likewise with MOCA score （r=-0.159～-0.265, P〈0.05）. After adjustment for age, education and diabetes duration, glucose variabilities including MAGE, MODD, MBG and SD were revealed negatively correlated with MMSE score （r=-0.153 ～ -0.198, P〈0.05）, MODD, LAGE, MBG and SD positively correlated with the ADL score （r=0.128～0.219, P〈0.05）, MAGE, MODD, MBG positively correlated with the GDS score （r=0.138～0.170, P〈0.05）, MAGE, MODD, LAGE, MBG and SD negatively correlated with the CDT score （r=-0.134～-0.205, P〈0.05）. Stepwise regression analysis showed that education, MAGE and SD were the main factors related to MMSE score which was as the dependent variety