血糖波动对60岁以上2型糖尿病患者认知功能的影响

目的探讨血糖波动对60岁以上2型糖尿病患者认知功能的影响。方法对108例60岁以上2型糖尿病患者行3d动态血糖监测系统（CGMS）监测，应用CGMS监测评价24h血糖平均值（MBG）及其标准差（s）；CGMS监测期间行认知功能评估量表测定，包括简易智力状态量表（MMSE）、加拿大蒙特利尔认知量表（MOCA）和画钟试验，统计分析标准差与上述3项神经心理学量表测定分数的相关性。结果标准差与MMSE分数呈显著负相关（r=-0．324，P〈0．01），与MOCA分数无关（r=-0．212，P=0．081），与画钟试验分数呈显著负相关（r=-0．325，P=0．001）；校正糖化血红蛋白（HbA1c）后，标准差与MMSE、MOCA、画钟试验分数均为负相关（r值分别为-0．387，-0．046，-0．292，均P〈0．05）；校正MBG后，标准差与MMSE、MOCA、画钟试验分数均呈显著负相关（r值分别为-0．314，-0．455，-0．345，均P〈0．01）。分别以MMSE、MOCA、画钟试验为应变量，多元逐步回归分析提示标准差是MMSE、MOCA、画钟试验分数的影响因素（β值分别为-0．378，-0．224，-0．345，均P〈0．05）。结论血糖波动对60岁以上2型糖尿病患者认知功能有影响，血糖波动大可能导致总体认知功能及执行功能下降。

Relationship between blood glucose excursion and cognitive performance in diabetic patients over 60 years old

Objective To explore relationship between excursion of blood glucose levels and cognitive performance in diabetic patients over aged 60 years.Methods A total of 108 diabetic patients over aged 60 years were recruited in this study and they wore under continuous blood glucose monitoring system (CGMS) for three days to evaluate excursion of their mean blood glucose (MBG) level and its standard deviation (SD).All the participants accepted cognitive function tests during continuous blood glucose monitoring, including mini mental status examination (MMSE), Montreal cognitive assessment (MOCA) and clock drawing test (CDT).Relationship of the SD of blood glucose level and cognitive performance in the three cognitive tests was assessed.Data were analyzed with CGMS software version 3.0.Results The SD reversely correlated with scores of MMSE (r = - 0.324, P ＜ 0.01 ) and CDT ( r =-0.325, P = 0.001 ), but they did not significantly correlate with MOCA scores (r = -0.212, P =0.081 ).Statistically significant difference was observed between the SD and scores of all three cognitive tests adjusted for glycosylated hemoglobin Alc (HbAlc) level (r = -0.387, -0.046 and -0.292, P =0.029, ＜0.001 and ＜ 0.001, respectively).The SD reversely correlated with scores of MMSE, MOCA and CDT adjusted for MBG (r= -0.314, -0.466 and -0.345, P ＜0.01, respectively).Results of multivariate linear regression analysis showed that the SD reversely correlated to scores of MMSE, MOCA and CDT (β = - 0.378, - 0.224 and - 0.346, all P ＜ 0.05).Conclusions Excursion of blood glucose levels can influence their cognitive performance in diabetic patients over aged 60 years, leading to decrease in their overall cognitive function and activities as its excursion large enough.