老年2型糖尿病患者认知功能障碍与平均血糖波动幅度的关系

摘要

Objective To investigate the relationship between mean amplitude of glycemic excursions (MAGE) and cognitive impairment in elderly patients with type 2 diabetes.Methods Totally 80 patients (aged ＞ 60 years) with type 2 diabetic were selected.According to the Montreal Cognitive Assessment (MoCA) score,the patients were divided into two groups:cognitive impairment group (31cases) and non-cognitive impairment group (49 cases).Then all subjects were observed by continuous glucose monitoring for 3 days including the mean blood glucose (MBG) and its standard deviation (SD),MAGE and numbers of glycemic excursion (NGE).Results Compared with noncognitive impairment group,diabetic course,fasting blood glucose,2 h postprandial glycemia,glycosylated hemoglobin (HbA1c) and body mass index (BMI) were significantly different with the cognitive impairment group (P＜0.05).Furthermore,MAGE,MBG and SD were obviously higher than those in the non-cognitive impairment group [(5.89 ± 2.17) mmol/L vs.(3.15 ± 0.60) mmol/L,t＝8.37,P＝0.00; (11.85±3.45) mmol/L vs.(8.23±1.73)mmol/L,t＝6.23,P＝0.00; (3.16±1.29)mmol/L vs.(1.26±0.42)mmol/L,t＝9.57,P＝0.00].MoCA scores of patients with type 2 diabetes were negatively correlated with MAGE (r ＝-0.891,P ＜ 0.01).After multiple linear regression analysis,diabetic course,2 h postprandial glycemia,MAGE and SD remained independently associated with cognitive impairment in type 2 diabetic patients (R2 ＝0.835,P＜0.05)Conclusions MAGE during a daily period is associated with cognitive impairment independent of fasting blood glucose,postprandial glycemia and HbA1c.%目的 探讨老年2型糖尿病患者认知功能障碍与平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)之间的关系,并评估其是否为独立影响认知功能的因素.方法 选择60岁以上老年2型糖尿病患者80例,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)进行认知功能测定,根据测定结果分为认知障碍组(31例)和非认知障碍组(49例);所有患者均行72 h连续皮下血糖监测,测定平均血糖(mean blood glucose,MBG)、标准差(standard deviation,SD)、日内MAGE及波动次数.结果 认知障碍组与非认知障碍组比较,糖尿病病程、空腹血糖、餐后2h血糖、糖化血红蛋白、体质指数差异均有统计学意义(均P＜0.05);MAGE[(5.89±2.17)mmol/L对(3.15±0.60) mmol/L,t＝8.37,P＝ 0.00]、MBG[(11.85±3.45)mrnol/L对(8.23±1.73)mmol/L,t＝ 6.23,P＝0.00]、SD[(3.16±1.29) mmol/L对(1.26±0.42)mmol/L,t＝9.57,P＝0.00]差异均有统计学意义.MAGE与MoCA评分呈负相关(r＝-0.891,P＜0.01);多元线性回归分析显示,糖尿病病程、餐后2h血糖、MAGE、SD与2型糖尿病患者认知功能障碍发病关系最为密切(β＝-0.244、-0.375、-1.186、-1.455,均P＜0.05).结论 日内MAGE不依赖于空腹血糖、餐后血糖及糖化血红蛋白与认知功能障碍密切相关.