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Qi L, Geng X, Feng R, Wu S, Fu T, Li N, Ji H, Cheng R, Wu H, Wu D, Huang L, Long Q, Wang X. Association of glycemic variability and prognosis in patients with traumatic brain injury: A retrospective study from the MIMIC-IV database. Diabetes Res Clin Pract 2024; 217:111869. [PMID: 39332533 DOI: 10.1016/j.diabres.2024.111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/28/2024] [Accepted: 09/24/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Elevated glycemic variability (GV) often occurs in intensive care unit (ICU) patients and is associated with patient prognosis. However, the association between GV and prognosis in ICU patients with traumatic brain injury (TBI) remains unclear. METHOD Clinical data of ICU patients with TBI were obtained from the Medical Information Mart for Intensive Care (MIMIC) -IV database. The coefficient of variation (CV) was utilized to quantify GV, while the Glasgow Coma Scale (GCS) was employed to evaluate the consciousness status of TBI patients. Pearson linear correlation analysis, linear regression, COX regression and restricted cubic spline (RCS) were used to investigate the relationship between CV and consciousness impairment, as well as the risk of in-hospital mortality. RESULT A total of 1641 ICU patients with TBI were included in the study from the MIMIC-IV database. Pearson linear correlation and restricted cubic spline (RCS) analysis results showed a negative linear relationship between CV and the last GCS (P = 0.002) with no evidence of nonlinearity (P for nonlinear = 0.733). Multivariable linear regression suggested a higher CV was associated with a lower discharge GCS [β (95 %CI) = -1.86 (-3.08 ∼ -0.65), P = 0.003]. Furthermore, multivariable COX regression indicated that CV ≥ 0.3 was a risk factor for in-hospital death in TBI patients [HR (95 %CI) = 1.74 (1.15-2.62), P = 0.003], and this result was also consistent across sensitivity and subgroup analyses. CONCLUSION Higher GV is related to poorer consciousness outcomes and increased risk of in-hospital death in ICU patients with TBI. Additional research is needed to understand the logical relationship between GV and TBI progression.
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Affiliation(s)
- Linrui Qi
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Xin Geng
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Rongliang Feng
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Neurosurgery, the First People's Hospital of Zhaoqing City, Zhaoqing 526060, China.
| | - Shuaishuai Wu
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Tengyue Fu
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Ning Li
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Hongming Ji
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Shanxi Provincial Key Laboratory of Intelligent, Big Data and Digital Neurosurgery, Shanxi Provincial Key Laboratory of Intelligent Brain Tumor, Taiyuan 030012, China.
| | - Rui Cheng
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Shanxi Provincial Key Laboratory of Intelligent, Big Data and Digital Neurosurgery, Shanxi Provincial Key Laboratory of Intelligent Brain Tumor, Taiyuan 030012, China.
| | - Hao Wu
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China.
| | - Dan Wu
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China.
| | - Lian Huang
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Qingshan Long
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Neurosurgery, Zhongshan Torch Development Zone People's Hospital, Zhongshan 528400, China.
| | - Xiangyu Wang
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Gruber JR, Ruf A, Süß ED, Tariverdian S, Ahrens KF, Schiweck C, Ebner-Priemer U, Edwin Thanarajah S, Reif A, Matura S. Impact of blood glucose on cognitive function in insulin resistance: novel insights from ambulatory assessment. Nutr Diabetes 2024; 14:74. [PMID: 39261457 PMCID: PMC11390747 DOI: 10.1038/s41387-024-00331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES Insulin resistance (IR)-related disorders and cognitive impairment lead to reduced quality of life and cause a significant strain on individuals and the public health system. Thus, we investigated the effects of insulin resistance (IR), and blood glucose fluctuations on cognitive function under laboratory and free-living conditions, using ecological momentary assessment (EMA). SUBJECTS/METHODS Baseline assessments included neuropsychological tests and blood analysis. Individuals were classified as either insulin-sensitive (<2) or insulin-resistant (≥2), based on their Homeostatic Model Assessment (HOMA-IR) values. Continuous glucose monitoring (CGM) using a percutaneous sensor was performed for 1 week. Using multiple linear regression, we examined the effects of HOMA-IR and CGM metrics on cognitive domains. Working memory (WM) performance, which was assessed using EMA, 4 times a day for 3 consecutive days, was matched to short-term pre-task CGM metrics. Multilevel analysis was used to map the within-day associations of HOMA-IR, short-term CGM metrics, and WM. RESULTS Analyses included 110 individuals (mean age 48.7 ± 14.3 years, 59% female, n = 53 insulin-resistant). IR was associated with lower global cognitive function (b = -0.267, P = 0.027), and WM (b = -0.316; P = 0.029), but not with executive function (b = -0.216; P = 0.154) during baseline. EMA showed that higher HOMA-IR was associated with lower within-day WM performance (β = -0.20, 95% CI -0.40 to -0.00). CGM metrics were not associated with cognitive performance. CONCLUSIONS The results confirm the association between IR and decrements in global cognitive functioning and WM, while no effects of CGM metrics were observed, making IR a crucial time point for intervention. Targeting underlying mechanisms (e.g., inflammation) in addition to glycemia could be promising to minimize adverse cognitive effects. Registered under https://drks.de/register/de identifier no. DRKS00022774.
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Affiliation(s)
- Judith R Gruber
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany.
| | - Alea Ruf
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
| | - Elena D Süß
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Sewin Tariverdian
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
| | - Kira F Ahrens
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
| | - Carmen Schiweck
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Sharmili Edwin Thanarajah
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Andreas Reif
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Silke Matura
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany
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Selçuk Tosun A, Lök N, Duran B, Akgul Gundogdu N. The effect of reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes: a randomised controlled trial. Psychogeriatrics 2024; 24:933-942. [PMID: 38877662 DOI: 10.1111/psyg.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 04/29/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Evidence suggests that reminiscence therapy can effectively reduce cognitive and psychological symptoms. This study was conducted to examine the effect of individual reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes. METHODS This study is an experimental type, randomised controlled study designed in pre-test - post-test design. The sample size of the study consisted of 58 older adults with type 2 diabetes, consisting of 29 intervention and 29 control subjects. The older adults in the intervention group were individually subjected to 5 weeks of reminiscence therapy in two sessions (each session 40-45 min) per week. No intervention was applied to the control group. Personal Information Form, Standardised Mini Mental Test, SF-36 Quality of Life and Beck Depression Inventory were used to collect the data. RESULTS While there was no significant difference between the pre-test Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group and the mean scores of those in the control group (P > 0.05), the difference between the Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention and control groups in the post-test was found to be statistically significant (P < 0.05). The post-test Mini Mental Test total score, SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group were higher than the older adults in the control group. It was determined that the post-test Beck Depression Inventory total mean scores of the older adults in the intervention group were lower than the older adults in the control group. CONCLUSION Reminiscence therapy can positively affect cognitive levels, quality of life and depression symptoms of older adults living in the community. Individual reminiscence therapy can be used as a nursing intervention in primary healthcare.
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Affiliation(s)
- Alime Selçuk Tosun
- Department of Public Health Nursing, Faculty of Nursing, University of Selçuk, Konya, Turkey
| | - Neslihan Lök
- Department of Psychiatric Nursing, Faculty of Nursing, University of Selçuk, Konya, Turkey
| | - Büşra Duran
- School of Health Sciences, KTO Karatay University, Konya, Türkiye
| | - Nurcan Akgul Gundogdu
- Department of Public Health Nursing, Faculty of Health Sciences, University of Bandirma Onyedi Eylul, Balikesir, Turkey
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Madetko-Alster N, Otto-Ślusarczyk D, Struga M, Kutyłowski M, Drzewińska A, Duszyńska-Wąs K, Migda B, Alster P. Glucose Metabolism and Cognitive Decline in Progressive Supranuclear Palsy and Corticobasal Syndrome: A Preliminary Study. J Clin Med 2024; 13:465. [PMID: 38256599 PMCID: PMC10816752 DOI: 10.3390/jcm13020465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple studies have analyzed the possible correlations between diabetes and Alzheimer's disease. Less is known about the context of cognitive deterioration among patients with atypical Parkinsonian syndromes and glucose metabolism impairment. The aim of this study was to evaluate the association between the impaired glucose metabolism and cognitive decline among patients with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). The study included 22 patients with PSP and CBS with disease durations varying from 3 to 6 years. The levels of glycated hemoglobin (HbA1C), fasting blood glucose, fasting C-peptide and the presence of microalbuminuria were evaluated, and oral glucose tolerance tests (OGTT) were performed. Based on the OGTT results, the glycemic variability, mean glycemia, glycemia standard deviation (SD) and coefficient of variation (%CV) were calculated. All patients underwent a three-Tesla brain magnetic resonance (MRI) examination and neuropsychological cognitive assessment with the use of standardized scales: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). A statistical analysis revealed that poor control of glycemia with high glycemic variability and increased atrophy of the medial temporal lobe among patients with PSP and CBS correlated with worse cognitive performance independent of age or sex, even among patients who did not fulfill the criteria for diabetes. The study results indicate the importance of glucose metabolism control and optimal treatment in the context of cognition maintenance among patients with PSP and CBS. Due to the relatively small number of analyzed patients, the issue requires further assessment. To the best of our knowledge, this is the first study discussing the role of glycemic variability in atypical Parkinsonian syndromes.
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Affiliation(s)
- Natalia Madetko-Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242 Warsaw, Poland;
| | - Dagmara Otto-Ślusarczyk
- Department of Biochemistry, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (D.O.-Ś.); (M.S.)
| | - Marta Struga
- Department of Biochemistry, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (D.O.-Ś.); (M.S.)
| | - Michał Kutyłowski
- Department of Radiology, Mazovian Brodno Hospital, Kondratowicza 8, 03-242 Warsaw, Poland;
| | - Agnieszka Drzewińska
- Department of Neurology, Mazovian Brodno Hospital, Kondratowicza 8, 03-242 Warsaw, Poland; (A.D.); (K.D.-W.)
| | - Karolina Duszyńska-Wąs
- Department of Neurology, Mazovian Brodno Hospital, Kondratowicza 8, 03-242 Warsaw, Poland; (A.D.); (K.D.-W.)
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242 Warsaw, Poland;
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Jang H, Lee S, An S, Park Y, Kim SJ, Cheon BK, Kim JH, Kim HJ, Na DL, Kim JP, Kim K, Seo SW. Association of Glycemic Variability With Imaging Markers of Vascular Burden, β-Amyloid, Brain Atrophy, and Cognitive Impairment. Neurology 2024; 102:e207806. [PMID: 38165363 PMCID: PMC10834128 DOI: 10.1212/wnl.0000000000207806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE We aimed to investigate the association between glycemic variability (GV) and neuroimaging markers of white matter hyperintensities (WMH), beta-amyloid (Aβ), brain atrophy, and cognitive impairment. METHODS This was a retrospective cohort study that included participants without dementia from a memory clinic. They all had Aβ PET, brain MRI, and standardized neuropsychological tests and had fasting glucose (FG) levels tested more than twice during the study period. We defined GV as the intraindividual visit-to-visit variability in FG levels. Multivariable linear regression and logistic regression were used to identify whether GV was associated with the presence of severe WMH and Aβ uptake with DM, mean FG levels, age, sex, hypertension, and presence of APOE4 allele as covariates. Mediation analyses were used to investigate the mediating effect of WMH and Aβ uptake on the relationship between GV and brain atrophy and cognition. RESULTS Among the 688 participants, the mean age was 72.2 years, and the proportion of female participants was 51.9%. Increase in GV was predictive of the presence of severe WMH (coefficient [95% CI] 1.032 [1.012-1.054]; p = 0.002) and increased Aβ uptake (1.005 [1.001-1.008]; p = 0.007). Both WMH and increased Aβ uptake partially mediated the relationship between GV and frontal-executive dysfunction (GV → WMH → frontal-executive; direct effect, -0.319 [-0.557 to -0.080]; indirect effect, -0.050 [-0.091 to -0.008]) and memory dysfunction (GV → Aβ → memory; direct effect, -0.182 [-0.338 to -0.026]; indirect effect, -0.067 [-0.119 to -0.015]), respectively. In addition, increased Aβ uptake completely mediated the relationship between GV and hippocampal volume (indirect effect, -1.091 [-2.078 to -0.103]) and partially mediated the relationship between GV and parietal thickness (direct effect, -0.00101 [-0.00185 to -0.00016]; indirect effect, -0.00016 [-0.00032 to -0.000002]). DISCUSSION Our findings suggest that increased GV is related to vascular and Alzheimer risk factors and neurodegenerative markers, which in turn leads to subsequent cognitive impairment. Furthermore, GV can be considered a potentially modifiable risk factor for dementia prevention.
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Affiliation(s)
- Hyemin Jang
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Sungjoo Lee
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Sungsik An
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Yuhyun Park
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Soo-Jong Kim
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Bo Kyoung Cheon
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Ji Hyun Kim
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Hee Jin Kim
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Duk L Na
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Jun Pyo Kim
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Kyunga Kim
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
| | - Sang Won Seo
- From the Alzheimer's Disease Convergence Research Center (H.J., S.A., Y.P., S.-J.K., B.K.C., J.H.K., H.J.K., D.L.N., J.P.K., S.W.S.), Samsung Medical Center; Department of Digital Health (H.J., S.L., K.K., S.W.S.), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University; Department of Neurology (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (H.J., H.J.K., J.P.K., S.W.S.), Samsung Medical Center; Happymind Clinic (D.L.N.); Biomedical Statistics Center (K.K.), Research Institute for Future Medicine, Samsung Medical Center; and Department of Data Convergence and Future Medicine (K.K.), Sungkyunkwan University School of Medicine, Seoul, Korea. Dr. Jang is currently at the Department of Neurology, Seoul National University Hospital, Korea
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Huang J, Kee MZL, Law EC, Sum KK, Silveira PP, Godfrey KM, Daniel LM, Tan KH, Chong YS, Chan SY, Eriksson JG, Meaney MJ, Huang JY. Parental and child genetic burden of glycaemic dysregulation and early-life cognitive development: an Asian and European prospective cohort study. Transl Psychiatry 2024; 14:2. [PMID: 38177108 PMCID: PMC10766615 DOI: 10.1038/s41398-023-02694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Insulin resistance and glucose metabolism have been associated with neurodevelopmental disorders. However, in the metabolically more susceptible Asian populations, it is not clear whether the genetic burden of glycaemic dysregulation influences early-life neurodevelopment. In a multi-ethnic Asian prospective cohort study in Singapore (Growing Up in Singapore Towards healthy Outcomes (GUSTO)), we constructed child and parental polygenic risk scores (PRS) for glycaemic dysregulation based on the largest genome-wide association studies of type 2 diabetes and fasting glucose among Asians. We found that child PRS for HOMA-IR was associated with a lower perceptual reasoning score at ~7 years (β = -0. 141, p-value = 0.024, 95% CI -0. 264 to -0. 018) and a lower WIAT-III mean score at ~9 years (β = -0.222, p-value = 0.001, 95% CI -0.357 to -0.087). This association were consistent in direction among boys and girls. These inverse associations were not influenced by parental PRS and were likely mediated via insulin resistance rather than mediators such as birth weight and childhood body mass index. Higher paternal PRS for HOMA-IR was suggestively associated with lower child perceptual reasoning at ~7 years (β = -0.172, p-value = 0.002, 95% CI -0.280 to -0.064). Replication analysis in a European cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, showed that higher child PRS for fasting glucose was associated with lower verbal IQ score while higher maternal PRS for insulin resistance was associated with lower performance IQ score in their children at ~8.5 years. In summary, our findings suggest that higher child PRS for HOMA-IR was associated with lower cognitive scores in both Asian and European replication cohorts. Differential findings between cohorts may be attributed to genetic and environmental factors. Further investigation of the functions of the genetic structure and ancestry-specific PRS and a more comprehensive investigation of behavioural mediators may help to understand these findings better.
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Affiliation(s)
- Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK.
| | - Michelle Z L Kee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Evelyn C Law
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Ka Kei Sum
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Patricia Pelufo Silveira
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychiatry, Faculty of Medicine and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lourdes Mary Daniel
- Department of Child Development, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of general practice and primary health care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychiatry, Faculty of Medicine and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada
- Brain-Body Initiative, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jonathan Yinhao Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Schaich CL, Bancks MP, Hayden KM, Ding J, Rapp SR, Bertoni AG, Heckbert SR, Hughes TM, Mongraw-Chaffin M. Visit-to-Visit Glucose Variability, Cognition, and Global Cognitive Decline: The Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab 2023; 109:e243-e252. [PMID: 37497618 PMCID: PMC10735301 DOI: 10.1210/clinem/dgad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
CONTEXT Higher visit-to-visit glucose variability (GV) is associated with dysglycemia and type 2 diabetes (T2D), key risk factors for cognitive decline. OBJECTIVE Evaluate the association of GV with cognitive performance and decline in racially/ethnically diverse older populations with and without T2D. METHODS We calculated the standard deviation of glucose (SDG), average real variability (ARV), and variability independent of the mean (VIM) among 4367 Multi-Ethnic Study of Atherosclerosis participants over 6 clinical examinations. Participants completed a cognitive assessment at the fifth examination, and a subset completed a second assessment 6 years later. We used multivariable linear regression to estimate the association of intraindividual GV with cognitive test scores after adjustments for cardiovascular risk factors and mean glucose level over the study period. RESULTS Two-fold increments in the VIM and SDG were associated with worse Cognitive Abilities Screening Instrument (CASI) performance, while two-fold increments in VIM and ARV were associated with worse Digit Symbol Coding test score. GV measures were not associated with change in CASI performance among 1834 participants with repeat CASI data 6 years later. However, among 229 participants with incident T2D, the SDG and VIM were associated with decline in CASI (-1.7 [95% CI: -3.1, -0.3] and -2.1 [-3.7, -0.5] points, respectively). In contrast, single-timepoint glucose and HbA1c were not associated with CASI decline among participants with or without incident T2D. CONCLUSION Higher visit-to-visit GV over 16 to 18 years is associated with worse cognitive performance in the general population, and with modest global cognitive decline in participants with T2D.
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Affiliation(s)
- Christopher L Schaich
- Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Jingzhong Ding
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Susan R Heckbert
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98105, USA
| | - Timothy M Hughes
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
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Cai W, Li Y, Guo K, Wu X, Chen C, Lin X. Association of glycemic variability with death and severe consciousness disturbance among critically ill patients with cerebrovascular disease: analysis of the MIMIC-IV database. Cardiovasc Diabetol 2023; 22:315. [PMID: 37974159 PMCID: PMC10652479 DOI: 10.1186/s12933-023-02048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The association of glycemic variability with severe consciousness disturbance and in-hospital all-cause mortality in critically ill patients with cerebrovascular disease (CVD) remains unclear, This study aimed to investigate the association of glycemic variability with cognitive impairment and in-hospital death. METHOD We extracted all blood glucose measurements of patients diagnosed with CVD from the Medical Information Mart for Intensive Care IV (MIMIC-IV). Glycemic variability was defined as the coefficient of variation (CV), which was determined using the ratio of standard deviation and the mean blood glucose levels. Cox hazard regression models were applied to analyze the link between glycemic variability and outcomes. We also analyzed non-linear relationship between outcome indicators and glycemic variability using restricted cubic spline curves. RESULTS The present study included 2967 patients diagnosed with cerebral infarction and 1842 patients diagnosed with non-traumatic cerebral hemorrhage. Log-transformed CV was significantly related to cognitive impairment and in-hospital mortality, as determined by Cox regression. Increasing log-transformed CV was approximately linearly with the risk of cognitive impairment and in-hospital mortality. CONCLUSION High glycemic variability was found to be an independent risk factor for severe cognitive decline and in-hospital mortality in critically ill patients with CVD. Our study indicated that enhancing stability of glycemic variability may reduced adverse outcomes in patients with severe CVD.
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Affiliation(s)
- Weimin Cai
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yaling Li
- Department Health Management Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 31000, China
| | - Kun Guo
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiao Wu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chao Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Lane, Wenzhou, 325000, China.
| | - Xinran Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2, Fuxue Lane, Wenzhou, 325000, China.
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Ma F, Zhang Q, Shi J, Li S, Wu L, Zhang H. Risk factors for cognitive dysfunction and glycemic management in older adults with type 2 diabetes mellitus: a retrospective study. BMC Endocr Disord 2023; 23:220. [PMID: 37821909 PMCID: PMC10565992 DOI: 10.1186/s12902-023-01476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Epidemiological evidence shows a robust relationship between cognitive dysfunction and type 2 diabetes mellitus (T2DM). This study identified major risk factors that might prevent or ameliorate T2DM-associated cognitive dysfunction in the realm of clinical practice. METHODS Using Mini-mental State Examination (MMSE) in the light of education level, we identified older adults with T2DM on admission aged 50 and above. We conducted this case-control study when eligible participants were divided into Cognitively Normal (CN) group and Cognitively Impaired (CI) group. Analytical data referred to demographic characteristics, clinical features, fluid biomarkers, and scale tests. RESULTS Of 596 records screened, 504 cases were included in the final analysis. Modified multivariate logistic regression analysis verified that homocysteine (OR = 2.048, 95%CI = 1.129-3.713), brain infarction (OR = 1.963, 95%CI = 1.197-3.218), dementia (OR = 9.430, 95%CI = 2.113-42.093), education level (OR = 0.605, 95%CI = 0.367-0.997), severity of dependence (OR = 1.996, 95%CI = 1.397-2.851), creatine kinase (OR = 0.514, 95%CI = 0.271-0.974) were significant risk factors of incident T2DM-related cognitive dysfunction in patients of advanced age. CONCLUSION Our study supported a robust relationship between T2DM and cognitive dysfunction. Our results provide clinicians with major risk factors for T2DM-related cognitive dysfunction, in particular the protective role of creatine kinase.
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Affiliation(s)
- Fanyuan Ma
- Department of Geriatrics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Qian Zhang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Juan Shi
- Department of Anatomy, Histology and Embryology, Air Force Medical University, Xi'an, 710032, China
| | - Shuaifeng Li
- Department of Spine Surgery, General Hospital of PLA Tibet Military Area Command, Lhasa, 850007, China
| | - Liping Wu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hua Zhang
- Department of Geriatrics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China.
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10
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Tian Y, Jing G, Zhang M. Insulin-degrading enzyme: Roles and pathways in ameliorating cognitive impairment associated with Alzheimer's disease and diabetes. Ageing Res Rev 2023; 90:101999. [PMID: 37414154 DOI: 10.1016/j.arr.2023.101999] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Accumulation of amyloid-β in the central nervous system is a common feature of Alzheimer's disease (AD) and diabetes-related cognitive impairment. Since the insulin-degrading enzyme (IDE) can break down amyloid-β plaques, there is considerable interest in using this enzyme to treat both neurological disorders. In this review, we have summarized the pre-clinical and clinical research on the potential application of IDE for the improvement of cognitive impairment. Furthermore, we have presented an overview of the main pathways that can be targeted to mitigate the progression of AD and the cognitive impairment caused by diabetes.
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Affiliation(s)
- Yue Tian
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guangchan Jing
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mengren Zhang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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11
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Pelle MC, Zaffina I, Giofrè F, Pujia R, Arturi F. Potential Role of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Cognitive Decline and Dementia in Diabetes Mellitus. Int J Mol Sci 2023; 24:11301. [PMID: 37511061 PMCID: PMC10379573 DOI: 10.3390/ijms241411301] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Dementia is a permanent illness characterized by mental instability, memory loss, and cognitive decline. Many studies have demonstrated an association between diabetes and cognitive dysfunction that proceeds in three steps, namely, diabetes-associated cognitive decrements, mild cognitive impairment (MCI; both non-amnesic MCI and amnesic MCI), and dementia [both vascular dementia and Alzheimer's disease (AD)]. Based on this association, this disease has been designated as type 3 diabetes mellitus. The underlying mechanisms comprise insulin resistance, inflammation, lipid abnormalities, oxidative stress, mitochondrial dysfunction, glycated end-products and autophagy. Moreover, insulin and insulin-like growth factor-1 (IGF-1) have been demonstrated to be involved. Insulin in the brain has a neuroprotective role that alters cognitive skills and alteration of insulin signaling determines beta-amyloid (Aβ) accumulation, in turn promoting brain insulin resistance. In this complex mechanism, other triggers include hyperglycemia-induced overproduction of reactive oxygen species (ROS) and inflammatory cytokines, which result in neuroinflammation, suggesting that antidiabetic drugs may be potential treatments to protect against AD. Among these, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are the most attractive antidiabetic drugs due to their actions on synaptic plasticity, cognition and cell survival. The present review summarizes the significant data concerning the underlying pathophysiological and pharmacological mechanisms between diabetes and dementia.
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Affiliation(s)
- Maria Chiara Pelle
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Isabella Zaffina
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Federica Giofrè
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Roberta Pujia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Franco Arturi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
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12
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Daniel JM, Lindsey SH, Mostany R, Schrader LA, Zsombok A. Cardiometabolic health, menopausal estrogen therapy and the brain: How effects of estrogens diverge in healthy and unhealthy preclinical models of aging. Front Neuroendocrinol 2023; 70:101068. [PMID: 37061205 PMCID: PMC10725785 DOI: 10.1016/j.yfrne.2023.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
Research in preclinical models indicates that estrogens are neuroprotective and positively impact cognitive aging. However, clinical data are equivocal as to the benefits of menopausal estrogen therapy to the brain and cognition. Pre-existing cardiometabolic disease may modulate mechanisms by which estrogens act, potentially reducing or reversing protections they provide against cognitive decline. In the current review we propose mechanisms by which cardiometabolic disease may alter estrogen effects, including both alterations in actions directly on brain memory systems and actions on cardiometabolic systems, which in turn impact brain memory systems. Consideration of mechanisms by which estrogen administration can exert differential effects dependent upon health phenotype is consistent with the move towards precision or personalized medicine, which aims to determine which treatment interventions will work for which individuals. Understanding effects of estrogens in both healthy and unhealthy models of aging is critical to optimizing the translational link between preclinical and clinical research.
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Affiliation(s)
- Jill M Daniel
- Department of Psychology and Brain Institute, Tulane University, New Orleans, LA, United States.
| | - Sarah H Lindsey
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Ricardo Mostany
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Laura A Schrader
- Department of Cell & Molecular Biology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Andrea Zsombok
- Department of Physiology and Brain Institute, Tulane University, New Orleans, LA, United States
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13
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Song J. Amygdala activity and amygdala-hippocampus connectivity: Metabolic diseases, dementia, and neuropsychiatric issues. Biomed Pharmacother 2023; 162:114647. [PMID: 37011482 DOI: 10.1016/j.biopha.2023.114647] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/04/2023] Open
Abstract
With rapid aging of the population worldwide, the number of people with dementia is dramatically increasing. Some studies have emphasized that metabolic syndrome, which includes obesity and diabetes, leads to increased risks of dementia and cognitive decline. Factors such as insulin resistance, hyperglycemia, high blood pressure, dyslipidemia, and central obesity in metabolic syndrome are associated with synaptic failure, neuroinflammation, and imbalanced neurotransmitter levels, leading to the progression of dementia. Due to the positive correlation between diabetes and dementia, some studies have called it "type 3 diabetes". Recently, the number of patients with cognitive decline due to metabolic imbalances has considerably increased. In addition, recent studies have reported that neuropsychiatric issues such as anxiety, depressive behavior, and impaired attention are common factors in patients with metabolic disease and those with dementia. In the central nervous system (CNS), the amygdala is a central region that regulates emotional memory, mood disorders, anxiety, attention, and cognitive function. The connectivity of the amygdala with other brain regions, such as the hippocampus, and the activity of the amygdala contribute to diverse neuropathological and neuropsychiatric issues. Thus, this review summarizes the significant consequences of the critical roles of amygdala connectivity in both metabolic syndromes and dementia. Further studies on amygdala function in metabolic imbalance-related dementia are needed to treat neuropsychiatric problems in patients with this type of dementia.
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Affiliation(s)
- Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Jeollanam-do, Republic of Korea.
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14
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Cuevas H, Stuifbergen AK, Hilsabeck RC, Sales A, Wood S, Kim J. The role of cognitive rehabilitation in people with type 2 diabetes: A study protocol for a randomized controlled trial. PLoS One 2023; 18:e0285553. [PMID: 37186584 PMCID: PMC10184896 DOI: 10.1371/journal.pone.0285553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).
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Affiliation(s)
- Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Alexa K. Stuifbergen
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Robin C. Hilsabeck
- Department of Neurology, Dell Medical School, Austin, Texas, United States of America
| | - Adam Sales
- Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, United States of America
| | - Shenell Wood
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jeeyeon Kim
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
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15
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Wang Y, Shi M, Li X. Effects of weight loss on cognitive function in patients with diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 200:110687. [PMID: 37105400 DOI: 10.1016/j.diabres.2023.110687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/08/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
AIMS Normalization of body weight is a treatment objective for diabetes. Therefore, anti-diabetic drugs that cause weight loss are widely used in clinics, with the aim of reducing the risk of chronic complications. However, the effect of weight loss on cognition in patients with diabetes is unclear. METHODS Embase, the Cochrane Library, PubMed, and the Web of Science were searched systematically, without study type restrictions, from inception to December 18, 2022. Weight loss was defined as a statistically significant decrease in body mass index (BMI) following an observation or intervention. We conducted an analysis of pooled data using a random-effects model. RESULTS A total of 619 participants in five studies were included. Weight loss was not associated with cognitive changes in patients with diabetes (standardized mean difference 0.50, 95% confidence interval -0.09 to 1.08). Subgroup analyses showed that this was not significantly affected by the duration of intervention or observation, or the size of the reduction in BMI. However, it was challenging to draw definitive conclusions regarding the effects of interventions and baseline BMI, because only one study was included. CONCLUSIONS Weight loss may be neutral to cognitive function in diabetes, but further studies are required to draw more definitive conclusions.
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Affiliation(s)
- Yaqi Wang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mei Shi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Dybjer E, Kumar A, Nägga K, Engström G, Mattsson-Carlgren N, Nilsson PM, Melander O, Hansson O. Polygenic risk of type 2 diabetes is associated with incident vascular dementia: a prospective cohort study. Brain Commun 2023; 5:fcad054. [PMID: 37091584 PMCID: PMC10118265 DOI: 10.1093/braincomms/fcad054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/28/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Type 2 diabetes and dementia are associated, but it is unclear whether the two diseases have common genetic risk markers that could partly explain their association. It is also unclear whether the association between the two diseases is of a causal nature. Furthermore, few studies on diabetes and dementia have validated dementia end-points with high diagnostic precision. We tested associations between polygenic risk scores for type 2 diabetes, fasting glucose, fasting insulin and haemoglobin A1c as exposure variables and dementia as outcome variables in 29 139 adults (mean age 55) followed for 20-23 years. Dementia diagnoses were validated by physicians through data from medical records, neuroimaging and biomarkers in cerebrospinal fluid. The dementia end-points included all-cause dementia, mixed dementia, Alzheimer's disease and vascular dementia. We also tested causal associations between type 2 diabetes and dementia through two-sample Mendelian randomization analyses. Seven different polygenic risk scores including single-nucleotide polymorphisms with different significance thresholds for type 2 diabetes were tested. A polygenic risk score including 4891 single-nucleotide polymorphisms with a P-value of <5e-04 showed the strongest association with different outcomes, including all-cause dementia (hazard ratio 1.11; Bonferroni corrected P = 3.6e-03), mixed dementia (hazard ratio 1.18; Bonferroni corrected P = 3.3e-04) and vascular dementia cases (hazard ratio 1.28; Bonferroni corrected P = 9.6e-05). The associations were stronger for non-carriers of the Alzheimer's disease risk gene APOE ε4. There was, however, no significant association between polygenic risk scores for type 2 diabetes and Alzheimer's disease. Furthermore, two-sample Mendelian randomization analyses could not confirm a causal link between genetic risk markers of type 2 diabetes and dementia outcomes. In conclusion, polygenic risk of type 2 diabetes is associated with an increased risk of dementia, in particular vascular dementia. The findings imply that certain people with type 2 diabetes may, due to their genetic background, be more prone to develop diabetes-associated dementia. This knowledge could in the future lead to targeted preventive strategies in clinical practice.
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Affiliation(s)
- Elin Dybjer
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-21428 Malmö, Sweden
| | - Atul Kumar
- MultiPark: Multidisciplinary Research focused on Parkinson's disease, Lund University, Box 117, SE-22100 Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Skånes universitetssjukhus, VE Minnessjukdomar, SE-20502 Malmö, Sweden
| | - Katarina Nägga
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-21428 Malmö, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Skånes universitetssjukhus, VE Minnessjukdomar, SE-20502 Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, SE-58183 Linköping, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-21428 Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- MultiPark: Multidisciplinary Research focused on Parkinson's disease, Lund University, Box 117, SE-22100 Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Skånes universitetssjukhus, VE Minnessjukdomar, SE-20502 Malmö, Sweden
- Brain Injury After Cardiac Arrest Research Group, Lund University, Box 117, SE-22100 Lund, Sweden
- WCMM – Wallenberg Centre for Molecular Medicine, Lund University, Sölvegatan 19, BMC D11, SE-22184 Lund, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-21428 Malmö, Sweden
- EpiHealth: Epidemiology for Health Strategic Research Area, Lund University, SUS Malmö, Jan Waldenströms gata 35, SE-20502 Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, SE-21428 Malmö, Sweden
- EpiHealth: Epidemiology for Health Strategic Research Area, Lund University, SUS Malmö, Jan Waldenströms gata 35, SE-20502 Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, SE-20502 Malmö, Sweden
- EXODIAB: Excellence in Diabetes Research in Sweden, Lund University, Box 117, SE-22100 Lund, Sweden
| | - Oskar Hansson
- MultiPark: Multidisciplinary Research focused on Parkinson's disease, Lund University, Box 117, SE-22100 Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Skånes universitetssjukhus, VE Minnessjukdomar, SE-20502 Malmö, Sweden
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Sugimoto T, Tokuda H, Miura H, Kawashima S, Ando T, Kuroda Y, Matsumoto N, Fujita K, Uchida K, Kishino Y, Sakurai T. Cross-sectional association of metrics derived from continuous glucose monitoring with cognitive performance in older adults with type 2 diabetes. Diabetes Obes Metab 2023; 25:222-228. [PMID: 36082514 DOI: 10.1111/dom.14866] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
AIM To examine the association between continuous glucose monitoring (CGM)-derived metrics and cognitive performance in older adults with type 2 diabetes (T2D). MATERIALS AND METHODS A total of 100 outpatients with T2D aged 70 years or older were analysed. Participants underwent CGM for 14 days. As CGM-derived metrics, mean sensor glucose (SG), glucose coefficient of variation (CV), time in range (TIR; 70-180 mg/dl), time above range (TAR; > 180 mg/dl) and time below range (TBR; < 70 mg/dl), were calculated. Participants underwent cognitive tests, including the Japanese version of the Montreal Cognitive Assessment (MoCA-J), a delayed word-recall test from the Alzheimer's Disease Assessment Scale-cognitive subscale, a digit symbol substitution test, a letter word fluency test, a trail-making test (TMT) and digit span test (DSP). RESULTS In multiple regression analyses adjusted for confounders, a higher mean SG was associated with a lower performance in MoCA-J and TMT part B (TMT-B) (P < .05). A higher TAR was associated with a lower performance in TMT-B and DSP-backward (P < .05). By contrast, a higher TIR was associated with better function in TMT-B and DSP-backward (P < .05). Furthermore, CV and TBR were not associated with any cognitive function. CONCLUSION Hyperglycaemia metrics and TIR derived from CGM are associated with cognitive functions, especially with executive function and working memory, in older adults with T2D.
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Affiliation(s)
- Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Haruhiko Tokuda
- Department of Clinical Laboratory, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Metabolic Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Home Care and Regional Liaison Promotion, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shuji Kawashima
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takafumi Ando
- Human-Centered Mobility Research Center, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nanae Matsumoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yoshinobu Kishino
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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18
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Fan L, Zhu X, Borenstein AR, Huang X, Shrubsole MJ, Dugan LL, Dai Q. Association of Circulating Caprylic Acid with Risk of Mild Cognitive Impairment and Alzheimer's Disease in the Alzheimer's Disease Neuroimaging Initiative (ADNI) Cohort. J Prev Alzheimers Dis 2023; 10:513-522. [PMID: 37357292 PMCID: PMC10442865 DOI: 10.14283/jpad.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Medium-chain fatty acids (MCFAs) can rapidly cross the blood-brain barrier and provide an alternative energy source for the brain. This study aims to determine 1) whether plasma caprylic acid (C8:0) is associated with risk of incident mild cognitive impairment (MCI) among baseline cognitively normal (CN) participants, and incident Alzheimer's Disease (AD) among baseline MCI participants; and 2) whether these associations differ by sex, comorbidity of cardiometabolic diseases, apolipoprotein E (APOE) ε4 alleles, and ADAS-Cog 13. METHODS Within the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort, plasma C8:0 was measured at baseline in 618 AD-free participants aged 55 to 91. Logistic regression models were used to estimate odds ratios (ORs) and 95% CIs with incident MCI and AD as dependent variables, separately. RESULTS The inverse association between circulating C8:0 and risk of incident MCI was of borderline significance. The inverse association between circulating levels of C8:0 and risk of incident MCI was significant among CN participants with ≥1 cardiometabolic diseases [OR (95% CI): 0.75 (0.58-0.98) (P=0.03)], those with one copy of APOE ε4 alleles [OR (95% CI): 0.43 (0.21-0.89) (P=0.02)], female [OR (95% CI): 0.60 (0.38-0.94) (P=0.02)], and ADAS-Cog 13 above the median [OR (95%CI): 0.69 (0.50-0.97)(P=0.03)] after adjusting for all covariates. CONCLUSION The inverse associations were present only among subgroups of CN participants, including female individuals, those with one or more cardiometabolic diseases, or one APOE ε4 allele, or higher ADAS-Cog 13 scores. If confirmed, this finding will facilitate precision prevention of MCI, in turn, AD among CN older adults.
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Affiliation(s)
- L Fan
- Qi Dai, M.D., Ph.D., Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738, USA, Phone: (615) 936-0707, Fax: (615) 343-5938, E-mail:
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19
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Lee DY, Kim J, Park S, Park SY, Yu JH, Seo JA, Kim NH, Yoo HJ, Kim SG, Choi KM, Baik SH, Han K, Kim NH. Fasting Glucose Variability and the Risk of Dementia in Individuals with Diabetes: A Nationwide Cohort Study. Diabetes Metab J 2022; 46:923-935. [PMID: 35609876 PMCID: PMC9723200 DOI: 10.4093/dmj.2021.0346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We investigated whether fasting glucose (FG) variability could predict the risk of dementia. METHODS This cohort study analyzed data from Koreans with diabetes after at least three health examinations by the Korean National Health Insurance Corporation between 2005 and 2010, which included at least one examination between 2009 and 2010. A total of 769,554 individuals were included, excluding those aged <40 years and those with dementia. FG variability was measured using the variability independent of the mean (FG-VIM). The incidence of dementia was defined by the International Classification of Diseases 10th Revision codes and prescription of anti-dementia medication and was subdivided into Alzheimer's disease (AD) and vascular dementia (VD). RESULTS During the 6.9-year follow-up, 54,837, 41,032, and 6,892 cases of all-cause dementia, AD, and VD, respectively, were identified. Cox proportional regression analyses showed that as the FG-VIM quartile increased, the risk of dementia serially increased after adjustment for metabolic factors, income status, and diabetes-related characteristics, including the mean FG. Participants in FG-VIM quartile 4 showed a 18%, 19%, and 17% higher risk for all-cause dementia, AD, and VD, respectively, than those in quartile 1; this particularly included non-obese patients with a longer duration of diabetes, high FG levels, dyslipidemia, and those taking glucose-lowering medications. Conversely, the baseline FG status and dementia showed a U-shaped association. CONCLUSION Increased FG variability over 5 years can predict the risk of dementia in individuals with diabetes in Korea. This finding was more pronounced in patients with less favorable metabolic profiles.
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Affiliation(s)
- Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jaeyoung Kim
- Research Institute for Skin Image, Korea University College of Medicine, Seoul, Korea
- Core Research & Development Center, Korea University Ansan Hospital, Ansan, Korea
| | - Sanghyun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
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20
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Sümbül Şekerci B, Şekerci A, Gelişin Ö. Association between the peripheral blood parameters and Alzheimer’s disease in patients with type-2 diabetes mellitus: a case–control study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Heise T, Piras de Oliveira C, Juneja R, Ribeiro A, Chigutsa F, Blevins T. What is the value of faster acting prandial insulin? Focus on ultra rapid lispro. Diabetes Obes Metab 2022; 24:1689-1701. [PMID: 35593434 PMCID: PMC9540401 DOI: 10.1111/dom.14773] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 01/09/2023]
Abstract
Rapid-acting insulins (RAIs) have been instrumental in the management of diabetes because of their improved postprandial glucose (PPG) control compared with regular human insulin. However, their absorption rate and time action following subcutaneous administration still falls short of the normal physiological response to meal consumption, increasing the risk of early postmeal hyperglycaemia and late postmeal hypoglycaemia. Increased demand for faster acting insulins, which can quickly control PPG excursions without increasing the risk of late hypoglycaemia, led to the development of ultra-rapid-acting insulins, including ultra-rapid lispro (URLi). URLi is a novel formulation of insulin lispro with accelerated absorption driven by two excipients: treprostinil, which increases local vasodilation, and citrate, which increases local vascular permeability. Clinical pharmacology studies consistently showed an earlier onset and shorter duration of action with URLi compared with Lispro. In a head-to-head study with Faster aspart, Aspart and Lispro, URLi was absorbed faster, provided earlier insulin action, and more closely matched physiological glucose response than the other insulins tested. URLi's unique pharmacokinetic properties increase its potential for improved PPG control beyond that achieved with RAIs. Indeed, in pivotal phase 3 trials, URLi was superior to Lispro for PPG control both at 1 and 2 hours after a meal in type 1 and type 2 diabetes with multiple daily injections, and in type 1 diabetes with continuous subcutaneous insulin infusion. This was achieved without increasing the risk of hypoglycaemia. In this review, we focus on the clinical and pharmacological evidence for URLi in the treatment of diabetes and discuss the potential benefits and considerations with URLi compared with RAIs.
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22
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Ehtewish H, Arredouani A, El-Agnaf O. Diagnostic, Prognostic, and Mechanistic Biomarkers of Diabetes Mellitus-Associated Cognitive Decline. Int J Mol Sci 2022; 23:6144. [PMID: 35682821 PMCID: PMC9181591 DOI: 10.3390/ijms23116144] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Cognitive dysfunctions such as mild cognitive impairment (MCI), Alzheimer's disease (AD), and other forms of dementia are recognized as common comorbidities of type 2 diabetes mellitus (T2DM). Currently, there are no disease-modifying therapies or definitive clinical diagnostic and prognostic tools for dementia, and the mechanisms underpinning the link between T2DM and cognitive dysfunction remain equivocal. Some of the suggested pathophysiological mechanisms underlying cognitive decline in diabetes patients include hyperglycemia, insulin resistance and altered insulin signaling, neuroinflammation, cerebral microvascular injury, and buildup of cerebral amyloid and tau proteins. Given the skyrocketing global rates of diabetes and neurodegenerative disorders, there is an urgent need to discover novel biomarkers relevant to the co-morbidity of both conditions to guide future diagnostic approaches. This review aims to provide a comprehensive background of the potential risk factors, the identified biomarkers of diabetes-related cognitive decrements, and the underlying processes of diabetes-associated cognitive dysfunction. Aging, poor glycemic control, hypoglycemia and hyperglycemic episodes, depression, and vascular complications are associated with increased risk of dementia. Conclusive research studies that have attempted to find specific biomarkers are limited. However, the most frequent considerations in such investigations are related to C reactive protein, tau protein, brain-derived neurotrophic factor, advanced glycation end products, glycosylated hemoglobin, and adipokines.
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Affiliation(s)
- Hanan Ehtewish
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar;
| | - Abdelilah Arredouani
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar;
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
| | - Omar El-Agnaf
- Division of Biological and Biomedical Sciences (BBS), College of Health & Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar;
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
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23
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Davis-Plourde KL, Mayeda ER, Lodi S, Filshtein T, Beiser A, Gross AL, Seshadri S, Glymour MM, Tripodis Y. Joint Models for Estimating Determinants of Cognitive Decline in the Presence of Survival Bias. Epidemiology 2022; 33:362-371. [PMID: 35383644 DOI: 10.1097/ede.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying determinants of cognitive decline is crucial for developing strategies to prevent Alzheimer's disease and related dementias. However, determinants of cognitive decline remain elusive, with inconsistent results across studies. One reason could be differential survival. Cognitive decline and many exposures of interest are associated with mortality making survival a collider. Not accounting for informative attrition can result in survival bias. Generalized estimating equations (GEE) and linear mixed-effects model (LME) are commonly used to estimate effects of exposures on cognitive decline, but both assume mortality is not informative. Joint models combine LME with Cox proportional hazards models to simultaneously estimate cognitive decline and the hazard of mortality. METHODS Using simulations, we compared estimates of the effect of a binary exposure on rate of cognitive decline from GEE, weighted GEE using inverse-probability-of-attrition weights, and LME to joint models under several causal structures of survival bias. RESULTS We found that joint models with correctly specified relationship between survival and cognition performed best, producing unbiased estimates and appropriate coverage. Even those with misspecified relationship between survival and cognition showed advantage under causal structures consistent with survival bias. We also compared these models in estimating the effect of education on cognitive decline after dementia diagnosis using Framingham Heart Study data. Estimates of the effect of education on cognitive decline from joint models were slightly attenuated with similar precision compared with LME. CONCLUSIONS In our study, joint models were more robust than LME, GEE, and weighted GEE models when evaluating determinants of cognitive decline.
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Affiliation(s)
- Kendra L Davis-Plourde
- From the Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Framingham Heart Study, Framingham, MA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA
- Department of Epidemiology and Biostatistics, San Francisco School of Medicine, University of California, San Francisco, CA
| | - Sara Lodi
- From the Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Teresa Filshtein
- Department of Epidemiology and Biostatistics, San Francisco School of Medicine, University of California, San Francisco, CA
| | - Alexa Beiser
- From the Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Framingham Heart Study, Framingham, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, San Francisco School of Medicine, University of California, San Francisco, CA
| | - Yorghos Tripodis
- From the Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Boston University Alzheimer's Disease Center, Boston, MA
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24
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Cheng H, Zhang Z, Zhang B, Zhang W, Wang J, Ni W, Miao Y, Liu J, Bi Y. Enhancement of Impaired Olfactory Neural Activation and Cognitive Capacity by Liraglutide, but Not Dapagliflozin or Acarbose, in Patients With Type 2 Diabetes: A 16-Week Randomized Parallel Comparative Study. Diabetes Care 2022; 45:1201-1210. [PMID: 35263425 DOI: 10.2337/dc21-2064] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The comparative neuroprotective effects of different antidiabetes drugs have not been characterized in randomized controlled trials. Here, we investigated the therapeutic effects of liraglutide, dapagliflozin, or acarbose treatment on brain functional alterations and cognitive changes in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Thirty-six patients with type 2 diabetes inadequately controlled with metformin monotherapy were randomized to receive liraglutide, dapagliflozin, or acarbose treatment for 16 weeks. Brain functional MRI (fMRI) scan and a battery of cognitive assessments were evaluated pre- and postintervention in all subjects. RESULTS The 16-week treatment with liraglutide significantly enhanced the impaired odor-induced left hippocampal activation with Gaussian random field correction and improved cognitive subdomains of delayed memory, attention, and executive function (all P < 0.05), whereas dapagliflozin or acarbose did not. Structural equation modeling analysis demonstrated that such improvements of brain health and cognitive function could be partly ascribed to a direct effect of liraglutide on left hippocampal activation (β = 0.330, P = 0.022) and delayed memory (β = 0.410, P = 0.004) as well as to the metabolic ameliorations of reduced waist circumference, decreased body fat ratio, and elevated fasting insulin (all P < 0.05). CONCLUSIONS Our head-to-head study demonstrated that liraglutide enhanced impaired brain activation and restored impaired cognitive domains in patients with type 2 diabetes, whereas dapagliflozin and acarbose did not. The results expand the clinical application of liraglutide and provide a novel treatment strategy for individuals with diabetes and a high risk of cognitive decline.
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Affiliation(s)
- Haiyan Cheng
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.,Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhou Zhang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wen Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenyu Ni
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yingwen Miao
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiani Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.,Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Michailidis M, Tata DA, Moraitou D, Kavvadas D, Karachrysafi S, Papamitsou T, Vareltzis P, Papaliagkas V. Antidiabetic Drugs in the Treatment of Alzheimer's Disease. Int J Mol Sci 2022; 23:4641. [PMID: 35563031 PMCID: PMC9102472 DOI: 10.3390/ijms23094641] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
The public health burden of type 2 diabetes mellitus and Alzheimer's disease is steadily increasing worldwide, especially in the population of older adults. Epidemiological and clinical studies suggest a possible shared pathophysiology between the two diseases and an increased risk of AD in patients with type 2 diabetes mellitus. Therefore, in recent years, there has been a substantial interest in identifying the mechanisms of action of antidiabetic drugs and their potential use in Alzheimer's disease. Human studies in patients with mild cognitive impairment and Alzheimer's disease have shown that administration of some antidiabetic medications, such as intranasal insulin, metformin, incretins, and thiazolidinediones, can improve cognition and memory. This review aims to examine the latest evidence on antidiabetic medications as a potential candidate for the treatment of Alzheimer's disease.
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Affiliation(s)
- Michalis Michailidis
- Laboratory of Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Despina A. Tata
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.A.T.); (D.M.)
| | - Despina Moraitou
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.A.T.); (D.M.)
| | - Dimitrios Kavvadas
- Histology and Embryology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.); (T.P.)
| | - Sofia Karachrysafi
- Histology and Embryology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.); (T.P.)
| | - Theodora Papamitsou
- Histology and Embryology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.); (T.P.)
| | - Patroklos Vareltzis
- Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
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Zhang L, Xu Y, Jiang X, Wu J, Liu F, Fan L, Li X, Yin G, Yang L. Impact of flash glucose monitoring on glycemic control varies with the age and residual β-cell function of patients with type 1 diabetes mellitus. J Diabetes Investig 2022; 13:552-559. [PMID: 34637185 PMCID: PMC8902407 DOI: 10.1111/jdi.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to explore the clinical factors associated with glycemic variability (GV) assessed with flash glucose monitoring (FGM), and investigate the impact of FGM on glycemic control among Chinese type 1 diabetes mellitus patients in a real-life clinical setting. MATERIALS AND METHODS A total of 171 patients were included. GV was assessed from FGM data. A total of 110 patients wore FGM continuously for 6 months (longitudinal cohort). Hemoglobin A1c (HbA1c), fasting and 2-h postprandial C-peptide, and glucose profiles were collected. Changes in HbA1c and glycemic parameters were assessed during a 6-month FGM period. RESULTS Individuals with high residual C-peptide (HRCP; 2-h postprandial C-peptide >200 pmol/L) had less GV than patients with low residual C-peptide ( 2-h postprandial C-peptide ≤200 pmol/L; P < 0.001). In the longitudinal cohort (n = 110), HbA1c and mean glucose decreased, time in range (TIR) increased during the follow-up period (P < 0.05). The 110 patients were further divided into age and residual C-peptide subgroups: (i) HbA1c and mean glucose were reduced significantly only in the subgroup aged ≤14 years during the follow-up period, whereas time below range also increased in this subgroup at 3 months (P = 0.047); and (ii) HbA1c improved in the HRCP subgroup at 3 and 6 months (P < 0.05). The mean glucose decreased and TIR improved significantly in the low residual C-peptide subgroup; however, TIR was still lower and time below range was higher than those of the HRCP subgroup at all time points (P < 0.05). CONCLUSIONS HRCP was associated with less GV. FGM wearing significantly reduced HbA1c, especially in pediatric patients and those with HRCP. Additionally, the mean glucose and TIR were also found to improve.
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Affiliation(s)
- Liyin Zhang
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Yaling Xu
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Xiaofang Jiang
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Jieru Wu
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Fang Liu
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Li Fan
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Xia Li
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Guangming Yin
- Department of UrologyThe Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Lin Yang
- Department of Metabolism and EndocrinologyNational Clinical Research Center for Metabolic DiseasesThe Second Xiangya Hospital of Central South UniversityChangshaChina
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Michailidis M, Moraitou D, Tata DA, Kalinderi K, Papamitsou T, Papaliagkas V. Alzheimer's Disease as Type 3 Diabetes: Common Pathophysiological Mechanisms between Alzheimer's Disease and Type 2 Diabetes. Int J Mol Sci 2022; 23:2687. [PMID: 35269827 PMCID: PMC8910482 DOI: 10.3390/ijms23052687] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/27/2022] Open
Abstract
Globally, the incidence of type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) epidemics is increasing rapidly and has huge financial and emotional costs. The purpose of the current review article is to discuss the shared pathophysiological connections between AD and T2DM. Research findings are presented to underline the vital role that insulin plays in the brain's neurotransmitters, homeostasis of energy, as well as memory capacity. The findings of this review indicate the existence of a mechanistic interplay between AD pathogenesis with T2DM and, especially, disrupted insulin signaling. AD and T2DM are interlinked with insulin resistance, neuroinflammation, oxidative stress, advanced glycosylation end products (AGEs), mitochondrial dysfunction and metabolic syndrome. Beta-amyloid, tau protein and amylin can accumulate in T2DM and AD brains. Given that the T2DM patients are not routinely evaluated in terms of their cognitive status, they are rarely treated for cognitive impairment. Similarly, AD patients are not routinely evaluated for high levels of insulin or for T2DM. Studies suggesting AD as a metabolic disease caused by insulin resistance in the brain also offer strong support for the hypothesis that AD is a type 3 diabetes.
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Affiliation(s)
- Michalis Michailidis
- Laboratory of Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.M.); (D.M.); (D.A.T.)
| | - Despina Moraitou
- Laboratory of Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.M.); (D.M.); (D.A.T.)
| | - Despina A. Tata
- Laboratory of Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.M.); (D.M.); (D.A.T.)
| | - Kallirhoe Kalinderi
- Laboratory of Medical Biology-Genetics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Theodora Papamitsou
- Histology and Embryology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
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Song J, Bai H, Xu H, Xing Y, Chen S. HbA1c Variability and the Risk of Dementia in Patients with Diabetes: A Meta-Analysis. Int J Clin Pract 2022; 2022:7706330. [PMID: 35685543 PMCID: PMC9159112 DOI: 10.1155/2022/7706330] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/20/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Variability of HbA1c has been related to the incidence micro and macrovascular complications in patients with diabetes. However, the association between of visit-to-visit variability of HbA1c and risk of dementia has not been fully determined. A meta-analysis was performed to comprehensively evaluate the above association. METHODS Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of dementia in diabetic patients with higher or lower variability of HbA1c. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results. RESULTS Five retrospective studies with 577592 diabetic patients were included, and 99% of them were with type 2 diabetes mellitus (T2DM). With a mean follow-up duration of 6.3 years, 31963 patients had newly diagnosed dementia. Pooled results showed that diabetic patients with higher HbA1c variability was associated with higher risk of dementia, as evidenced by studies with coefficient of variation (CV: hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.003-1.120; p=0.04; I 2 = 47%) and standard deviation (SD : HR: 1.19; 95% CI: 1.06-1.32; p=0.002; I 2 = 0%) of HbA1c in continuous variables, and CV of HbA1c (HR: 1.18; 95% CI: 1.08-1.28; p < 0.001; I 2 = 31%) in categorized variables. CONCLUSIONS Higher variability of HbA1c is associated with a higher incidence of dementia in patients with diabetes.
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Affiliation(s)
- Jingjing Song
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Hongying Bai
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Hui Xu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Yuanyuan Xing
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Si Chen
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
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Duc Nguyen H, Oh H, Yu BP, Hoang NMH, Jo WH, Young Chung H, Kim MS. Associations between Prolactin, Diabetes, and Cognitive Impairment: A Literature Review. Neuroendocrinology 2022; 112:856-873. [PMID: 34963126 DOI: 10.1159/000521653] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Converging evidence indicates prolactin (PRL) and diabetes play an important role in the pathophysiology of cognitive impairment. However, little is known about the mechanisms responsible for the effects of PRL and diabetes on cognitive impairment. SUMMARY We summarize and review the available literature and current knowledge of the association between PRL and diabetes on aspects of cognitive impairment. KEY MESSAGES The phosphatidylinositol 3-kinase/protein kinase B pathway is central to the molecular mechanisms underlying how PRL and diabetes interact in cognitive impairment. Further work is needed to identify the interaction between PRL and diabetes, especially in the molecular aspects of cognitive impairment, which can suggest novel strategies for cognitive dysfunction treatment.
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Affiliation(s)
- Hai Duc Nguyen
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon, Republic of Korea,
| | - Hojin Oh
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon, Republic of Korea
| | - Byung Pal Yu
- Department of Physiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ngoc Minh Hong Hoang
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon, Republic of Korea
| | - Won Hee Jo
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon, Republic of Korea
| | - Hae Young Chung
- Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Min-Sun Kim
- Department of Pharmacy, College of Pharmacy and Research Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon, Republic of Korea
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Chung JY, Kim OY, Song J. Role of ketone bodies in diabetes-induced dementia: sirtuins, insulin resistance, synaptic plasticity, mitochondrial dysfunction, and neurotransmitter. Nutr Rev 2021; 80:774-785. [PMID: 34957519 PMCID: PMC8907488 DOI: 10.1093/nutrit/nuab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Patients with type 2 diabetes can have several neuropathologies, such as memory deficits. Recent studies have focused on the association between metabolic imbalance and neuropathological problems, and the associated molecular pathology. Diabetes triggers neuroinflammation, impaired synaptic plasticity, mitochondrial dysfunction, and insulin resistance in the brain. Glucose is a main energy substrate for neurons, but under certain conditions, such as fasting and starvation, ketone bodies can be used as an energy fuel for these cells. Recent evidence has shed new light on the role of ketone bodies in regulating several anti-inflammation cellular pathways and improving glucose metabolism, insulin action, and synaptic plasticity, thereby being neuroprotective. However, very high amount of ketone bodies can be toxic for the brain, such as in ketoacidosis, a dangerous complication that may occur in type 1 diabetes mellitus or alcoholism. Recent findings regarding the relationship between ketone bodies and neuropathogenesis in dementia are reviewed in this article. They suggest that the adequately low amount of ketone bodies can be a potential energy source for the treatment of diabetes-induced dementia neuropathology, considering the multifaceted effects of the ketone bodies in the central nervous system. This review can provide useful information for establishing the therapeutic guidelines of a ketogenic diet for diabetes-induced dementia.
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Affiliation(s)
- Ji Yeon Chung
- Department of Neurology, Chosun University Medical School, Gwangju, Republic of Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition and the Department of Health Sciences, Dong-A University, Busan, Republic of Korea
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun, Jeollanam-do, Republic of Korea
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Ribeiro R, Santos AC, Calazans MO, De Oliveira ACP, Vieira LB. Is resveratrol a prospective therapeutic strategy in the co-association of glucose metabolism disorders and neurodegenerative diseases? Nutr Neurosci 2021; 25:2442-2457. [PMID: 34514962 DOI: 10.1080/1028415x.2021.1972514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: The mechanism behind the progression of Mild Cognitive Impairment (MCI) to Alzheimer's disease (AD) remains poorly understood. However some evidence pointed out that the co-occurrence of metabolic conditions affecting glucose homeostasis, as type 2 diabetes mellitus (T2DM), may be an important catalyst in this context. Notably, candidate drugs which modulate common pathways in the development of MCI-to-AD mediated by T2DM may offer likely therapy for AD. Nonetheless, limited pharmacological alternatives that modulate common pathways in T2DM, MCI, and AD are available. In the recent decades, studies have shown that resveratrol may act as a neuroprotective compound, but little is known about its potential in improving cognitive and metabolic aspects associated with AD progression mediated by the co-association between TDM2-MCI.Methods: In this review, we discuss possible protective mechanisms of resveratrol on shared pathways associated with AD progression mediated by T2DM-MCI co-occurrence.Results: Some studies indicated that insulin resistance and hyperglycemia may be also a T2DM risk factor for the progression of MCI-to-AD, promoting alterations in metabolic pathways associated with neuronal plasticity, and increasing pro-inflammatory environment. Interestingly, basic research and clinical trials indicate that resveratrol may modulate those pathways, showing a potential neuroprotective effect of this polyphenol.Conclusion: Therefore, there is not enough clinical data supporting the translational therapeutic use of resveratrol in this scenario.
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Affiliation(s)
- R Ribeiro
- Departamento de Farmacologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - A C Santos
- Departamento de Farmacologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M O Calazans
- Departamento de Farmacologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - A C P De Oliveira
- Departamento de Farmacologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - L B Vieira
- Departamento de Farmacologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Lee CH, Lui DTW, Cheung CYY, Woo YC, Fong CHY, Yuen MMA, Shea YF, Siu DCW, Chan KH, Chow WS, Lam KSL. Different glycaemia-related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes-A sex-specific analysis of the Hong Kong diabetes database. Diabetes Metab Res Rev 2021; 37:e3401. [PMID: 32870568 DOI: 10.1002/dmrr.3401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/01/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
AIMS Sexual dimorphism has been reported in the epidemiology, neurobiologic susceptibility and clinical presentation of Alzheimer's disease (AD). As poor glycaemic control is associated with increased risks of AD, we aimed to investigate whether glycaemia-related risk factors also differ between men and women, using a retrospective, sex-specific analysis of a large Chinese cohort with diabetes. MATERIALS & METHODS A total of 85,514 Chinese individuals with type 2 diabetes (T2D; 46,783 women and 38,731 men), aged ≥60 years, were identified from electronic health records and observed for incident AD. Multivariable Cox regression analysis was used to evaluate the associations with incident AD of several glycaemia-related risk factors, including severe hypoglycaemia, mean HbA1c and indices of HbA1c variability, in men and women separately. RESULTS Over a median follow-up of 6 years, women had a higher incidence of AD than men (2.3% vs. 1.2%, p < 0.001). Both men and women shared the same independent non-glycaemic clinical predictors, which included older age, lower body mass index and longer duration of diabetes. However, for glycaemia-related risk factors, we observed that severe hypoglycaemia and indices of HbA1c variability were independent predictors of incident AD in women but not in men, and the associations were irrespective of their baseline glycaemic control and duration of diabetes. CONCLUSIONS Our findings highlighted that glycaemia-related risk factors for incident AD differ between men and women with T2D. Strategies to maintain glycaemic stability and avoid severe hypoglycaemia might be especially important to preserve healthy cognition in older women with diabetes.
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Affiliation(s)
- Chi-Ho Lee
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - David T W Lui
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Chloe Y Y Cheung
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Yu-Cho Woo
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Carol H Y Fong
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Michele M A Yuen
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Yat-Fung Shea
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - David C W Siu
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Koon-Ho Chan
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Wing-Sun Chow
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Karen S L Lam
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China
- Department of Medicine, University of Hong Kong, Hong Kong, China
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Xia W, Luo Y, Chen YC, Chen H, Ma J, Yin X. Glucose Fluctuations Are Linked to Disrupted Brain Functional Architecture and Cognitive Impairment. J Alzheimers Dis 2021; 74:603-613. [PMID: 32065795 DOI: 10.3233/jad-191217] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) accelerates cognitive decline, which is believed to be triggered by aberrant neural activity. OBJECTIVE To explore how glucose fluctuations impact brain functional architecture and cognition in T2DM patients. METHODS T2DM patients were divided according to glycemic variability, forming two categories: patients with fluctuating glucose levels and patients with stable glucose levels. Degree centrality (DC) was calculated within the cerebral gray matter of each participant and was compared among the two patient groups and a healthy control group. The relationships between glucose fluctuations and aberrant DC and cognitive performance, as well as the relationship between aberrant DC and cognitive performance, were further explored. RESULTS Compared with T2DM patients with stable glucose levels, T2DM patients with fluctuating glucose levels exhibited significantly worse performance on the Montreal Cognitive Assessment, Trail Making Test-B (TMT-B), and verbal fluency test (VFT), as well as significant decreases in DC in certain regions, most of which were within the default mode network. In the combined T2DM group, the mean amplitude of glycemic excursions (MAGE) was positively correlated with TMT-B scores and negatively correlated with VFT scores. Moreover, the MAGE was negatively correlated with DC in the left medial prefrontal cortex (mPFC). In addition, TMT-B scores were negatively correlated with reduced DC in the left mPFC. CONCLUSION These findings further contribute to the mounting evidence of the effects of glycemic variability on the diabetic brain. Tightened control of glucose fluctuations might prevent cognitive decline and changes in brain functional architecture in T2DM individuals.
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Affiliation(s)
- Wenqing Xia
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yong Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Li FR, Yang HL, Zhou R, Zheng JZ, Chen GC, Wu XX, Zou MC, Wang JY, Fu Q, Wu XB. Influence of Diabetes Duration and Glycemic Control on Dementia: A Cohort Study. J Gerontol A Biol Sci Med Sci 2021; 76:2062-2070. [PMID: 34331763 DOI: 10.1093/gerona/glab221] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the influence of diabetes duration and glycemic control, assessed by glycated hemoglobin (HbA1c) levels, on risk of incident dementia. METHODS The present study is a prospective study of 461,563 participants from the UK Biobank. The age at diabetes diagnosis was determined by self-report. Diabetes duration was calculated as baseline age minus age at diagnosis. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (CIs). RESULTS During a median follow-up of 8.1 y, 2,233 dementia cases were recorded. As compared with normoglycemic individuals, individuals with diabetes had higher risk of all-cause dementia, and the risk increased with increasing duration of diabetes; compared with participants with diabetes duration of <5 y, the multivariable-adjusted HRs (95% CIs) were 1.49 (1.12-1.97), 1.71 (1.21-2.41), and 2.15 (1.60-2.90) for those with diabetes durations ≥5 to < 10, ≥10 to <15, and ≥ 15 y, respectively (P for trend < 0.001). Among participants with diabetes, those with both longer diabetes duration (diabetes duration ≥10 y) and poor glycemic control (HbA1c ≥8%) had the highest risk of All-cause dementia (multivariable-adjusted HR =2.07, 95% CI 1.45, 2.94), compared with patients with shorter duration of diabetes and better glycemic control (diabetes duration <10 y and HbA1c <8%). CONCLUSIONS Diabetes duration appeared to be associated with the risk of incident dementia due to factors beyond glycemic control. Clinicians should consider not only glycemic control but also diabetes duration in dementia risk assessments for patients with diabetes.
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Affiliation(s)
- Fu-Rong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Hai-Lian Yang
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Jia-Zhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Guo-Chong Chen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA
| | - Xiao-Xiang Wu
- Department of General Surgery, 157th Hospital, General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Meng-Chen Zou
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing-Ya Wang
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
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Chung H, Lee J, Kim J, Roh E, Lee YB, Hong SH, Yu J, Kim N, Yoo H, Seo J, Kim S, Kim N, Baik S, Choi K. Fasting plasma glucose variability in midlife and risk of Parkinson's disease: A nationwide population-based study. DIABETES & METABOLISM 2021; 47:101195. [DOI: 10.1016/j.diabet.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
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Lin L, Zhang R, Huang H, Zhu Y, Li Y, Dong X, Shen S, Wei L, Chen X, Christiani DC, Wei Y, Chen F. Mendelian Randomization With Refined Instrumental Variables From Genetic Score Improves Accuracy and Reduces Bias. Front Genet 2021; 12:618829. [PMID: 33868364 PMCID: PMC8044958 DOI: 10.3389/fgene.2021.618829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/01/2021] [Indexed: 11/15/2022] Open
Abstract
Mendelian randomization (MR) can estimate the causal effect for a risk factor on a complex disease using genetic variants as instrument variables (IVs). A variety of generalized MR methods have been proposed to integrate results arising from multiple IVs in order to increase power. One of the methods constructs the genetic score (GS) by a linear combination of the multiple IVs using the multiple regression model, which was applied in medical researches broadly. However, GS-based MR requires individual-level data, which greatly limit its application in clinical research. We propose an alternative method called Mendelian Randomization with Refined Instrumental Variable from Genetic Score (MR-RIVER) to construct a genetic IV by integrating multiple genetic variants based on summarized results, rather than individual data. Compared with inverse-variance weighted (IVW) and generalized summary-data-based Mendelian randomization (GSMR), MR-RIVER maintained the type I error, while possessing more statistical power than the competing methods. MR-RIVER also presented smaller biases and mean squared errors, compared to the IVW and GSMR. We further applied the proposed method to estimate the effects of blood metabolites on educational attainment, by integrating results from several publicly available resources. MR-RIVER provided robust results under different LD prune criteria and identified three metabolites associated with years of schooling and additional 15 metabolites with indirect mediation effects through butyrylcarnitine. MR-RIVER, which extends score-based MR to summarized results in lieu of individual data and incorporates multiple correlated IVs, provided a more accurate and powerful means for the discovery of novel risk factors.
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Affiliation(s)
- Lijuan Lin
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ruyang Zhang
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,China International Cooperation Center for Environment and Human Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
| | - Hui Huang
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ying Zhu
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Xuesi Dong
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Sipeng Shen
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Liangmin Wei
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - David C Christiani
- China International Cooperation Center for Environment and Human Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yongyue Wei
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,China International Cooperation Center for Environment and Human Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,China International Cooperation Center for Environment and Human Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
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Tang X, Cardoso MA, Yang J, Zhou JB, Simó R. Impact of Intensive Glucose Control on Brain Health: Meta-Analysis of Cumulative Data from 16,584 Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2021; 12:765-779. [PMID: 33548021 PMCID: PMC7947088 DOI: 10.1007/s13300-021-01009-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/23/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Despite growing evidence that type 2 diabetes is associated with dementia, the question of whether intensive glucose control can prevent or arrest cognitive decline remains unanswered. In the analysis reported here, we explored the effect of intensive glucose control versus standard care on brain health, including structural abnormalities of the brain (atrophy, white matter hyperintensities, lacunar infarction, and cerebral microbleeds), cognitive dysfunction, and risk of dementia. METHODS We searched the PubMed and Embase databases, the Web of Science website, and the Clinicaltrial.gov registry for studies published in English prior to July 2020. Only studies with a randomized controlled trial (RCT) design were considered. We analyzed structural abnormalities of the brain (atrophy, white matter hyperintensities, lacunar infarction, and cerebral microbleeds), cognitive function (cognitive impairment, executive function, memory, attention, and information-processing speed), and dementia (Alzheimer's disease, vascular dementia, and mixed dementia). RESULTS Six studies (5 different RCTs) with 16,584 participants were included in this meta-analysis. One study that compared structural changes between groups receiving intensive versus conventional glucose control measures reported non-significant results. The results of the five studies, comprising four cohorts, indicated a significantly poorer decline in cognitive function in the intensive glucose control group (β - 0.03, 95% confidence interval [CI] - 0.05 to - 0.02) than in the conventional glucose control group. Further subgroup analysis showed a significant difference in the change in cognitive performance in composite cognitive function (β - 0.03, 95% CI - 0.05 to - 0.01) and memory (β - 0.13, 95% CI - 0.25 to - 0.02). One trial evaluated the prevalence of cognitive impairment and dementia between groups receiving intensive and conventional glucose control, respectively, and the differences were insignificant. CONCLUSION This meta-analysis suggests that intensive glucose control in patients with type 2 diabetes can slow down cognitive decline, especially the decline in composite cognition and memory function. However, further studies are necessary to confirm the impact of strict glucose control on structural abnormalities in the brain and the risk of dementia.
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Affiliation(s)
- Xingyao Tang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Marly A Cardoso
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Jinkui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Santiago JA, Potashkin JA. The Impact of Disease Comorbidities in Alzheimer's Disease. Front Aging Neurosci 2021; 13:631770. [PMID: 33643025 PMCID: PMC7906983 DOI: 10.3389/fnagi.2021.631770] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
A wide range of comorbid diseases is associated with Alzheimer's disease (AD), the most common neurodegenerative disease worldwide. Evidence from clinical and molecular studies suggest that chronic diseases, including diabetes, cardiovascular disease, depression, and inflammatory bowel disease, may be associated with an increased risk of AD in different populations. Disruption in several shared biological pathways has been proposed as the underlying mechanism for the association between AD and these comorbidities. Notably, inflammation is a common dysregulated pathway shared by most of the comorbidities associated with AD. Some drugs commonly prescribed to patients with diabetes and cardiovascular disease have shown promising results in AD patients. Systems-based biology studies have identified common genetic factors and dysregulated pathways that may explain the relationship of comorbid disorders in AD. Nonetheless, the precise mechanisms for the occurrence of disease comorbidities in AD are not entirely understood. Here, we discuss the impact of the most common comorbidities in the clinical management of AD patients.
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Affiliation(s)
| | - Judith A Potashkin
- Cellular and Molecular Pharmacology Department, Center for Neurodegenerative Diseases and Therapeutics, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
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Watt C, Sanchez-Rangel E, Hwang JJ. Glycemic Variability and CNS Inflammation: Reviewing the Connection. Nutrients 2020; 12:nu12123906. [PMID: 33371247 PMCID: PMC7766608 DOI: 10.3390/nu12123906] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
Glucose is the primary energy source for the brain, and exposure to both high and low levels of glucose has been associated with numerous adverse central nervous system (CNS) outcomes. While a large body of work has highlighted the impact of hyperglycemia on peripheral and central measures of oxidative stress, cognitive deficits, and vascular complications in Type 1 and Type 2 diabetes, there is growing evidence that glycemic variability significantly drives increased oxidative stress, leading to neuroinflammation and cognitive dysfunction. In this review, the latest data on the impact of glycemic variability on brain function and neuroinflammation will be presented. Because high levels of oxidative stress have been linked to dysfunction of the blood-brain barrier (BBB), special emphasis will be placed on studies investigating the impact of glycemic variability on endothelial and vascular inflammation. The latest clinical and preclinical/in vitro data will be reviewed, and clinical/therapeutic implications will be discussed.
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Supasitthumrong T, Tunvirachaisakul C, Aniwattanapong D, Tangwongchai S, Chuchuen P, Tawankanjanachot I, Snabboon T, Hemrungrojn S, Carvalho AF, Maes M. Peripheral Blood Biomarkers Coupled with the Apolipoprotein E4 Genotype Are Strongly Associated with Semantic and Episodic Memory Impairments in Elderly Subjects with Amnestic Mild Cognitive Impairment and Alzheimer's Disease. J Alzheimers Dis 2020; 71:797-811. [PMID: 31424390 DOI: 10.3233/jad-190114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Apolipoprotein E4 (ApoE4) genotype is strongly associated with Alzheimer's disease (AD), although the presence of the ApoE4 allele alone is not sufficient to explain AD. The pathophysiology of amnestic mild cognitive impairment (aMCI) remains unclear. OBJECTIVE This study aims to examine associations between peripheral blood biomarkers coupled with ApoE4 and episodic and semantic memory. METHODS The CERAD battery was completed and various biomarkers were assayed in 60 subjects with aMCI, 60 with AD, and 62 healthy controls. RESULTS Deficits in semantic and episodic memory were significantly predicted by anion gap and bicarbonate, albumin, and glucose coupled with ApoE4. Furthermore, these peripheral biomarkers interacted with ApoE to predict greater memory impairments. CONCLUSIONS Peripheral blood biomarkers may interact with pathways related to ApoE4 to predict greater semantic and episodic memory impairments, thus contributing to the pathophysiology of aMCI and AD. Our data suggest that the transition from aMCI to AD could at least in some cases be associated with significant interactions between ApoE4 and those peripheral blood biomarkers.
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Affiliation(s)
| | | | - Daruj Aniwattanapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Phenphichcha Chuchuen
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Thiti Snabboon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Solaphat Hemrungrojn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.,IMPACT Strategic Research Center, Deakin University, Geelong, Australia
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Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. Nutrients 2020; 12:nu12113367. [PMID: 33139628 PMCID: PMC7693664 DOI: 10.3390/nu12113367] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.
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Wu J, Tao Z, Song Z, Zhang Y, Sun H, Wang J, Shen J. Validation and psychometric properties of the self-efficacy for Appropriate Medication Use Scale in elderly Chinese patients. Int J Clin Pharm 2020; 43:586-594. [PMID: 33044679 DOI: 10.1007/s11096-020-01167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
Background Self-efficacy for appropriate medication use is an important construct when evaluating the optimal use of medications. However, no instrument that assesses this construct in elderly Chinese patients has been shown to have valid psychometric properties. Objective To investigate the psychometric properties of the Chinese version of the self-efficacy for Appropriate Medication Use Scale in elderly patients with type 2 diabetes. Setting Geriatric patients were recruited from the endocrinology department of a tertiary hospital in Shanghai, China. Method Self-efficacy was assessed by the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in subjects who were at least 65 years old. Exploratory and confirmatory factor analyses were used to develop a psychometrically sound model of the scale. Main outcome measures Internal and test-retest reliability; convergent and discriminant validity of the scale; model fit indices of the factor model. Results The two-factor model of the self-efficacy for Appropriate Medication Use Scale was not suitable for elderly patients with respect to both item factor loadings and model fit indices. Conceptually overlapping scale items emerged when the scale was used in these patients. The final model developed appeared to achieve an ideal model fit and presented acceptable convergent and discriminant validity. Conclusions This study presented a Chinese version of the self-efficacy for Appropriate Medication Use Scale with psychometrically sound properties that will enable pharmacists, nurses and physicians to prospectively evaluate the impact of medication self-efficacy on a variety of health outcomes in elderly patients with type 2 diabetes.
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Affiliation(s)
- Jianbo Wu
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Zhujun Tao
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Zhongjuan Song
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Yunxuan Zhang
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Hua Sun
- Department of Endocrinology, Huadong Hospital, Fudan University, Shanghai, China
| | - Jiaofeng Wang
- Department of Geriatrics, Huadong Hospital, Fudan University, Shanghai, China
| | - Jie Shen
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China.
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He WJ, Cao DM, Chen YB, Shi JJ, Hu T, Zhang ZT, Lan T, Tang D, Wang SM. Explore of the beneficial effects of Huang-Lian-Jie-Du Decoction on diabetic encephalopathy in db/db mice by UPLC-Q-Orbitrap HRMS/MS based untargeted metabolomics analysis. J Pharm Biomed Anal 2020; 192:113652. [PMID: 33039912 DOI: 10.1016/j.jpba.2020.113652] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/10/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022]
Abstract
Diabetic encephalopathy (DE) is a severe diabetic complication with cognitive dysfunction. Huang-Lian-Jie-Du Decoction (HLJDD), a famous traditional Chinese formula, is effective for the treatment of diabetes mellitus and Alzheimer's disease in clinical practices, however, the therapeutic effects and the underlying mechanisms of HLJDD on DE is unclear yet. With this purpose, behavior test, brain histological and biochemical analysis were estimated to assess the beneficial effects of HLJDD on DE. Plasma samples were collected for metabolomics analysis based on UPLC-Q-Orbitrap HRMS/MS and chemometric analysis. As a result, morris water maze test revealed that HLJDD could effectively improve the learning and memory abilities in db/db mice. Brain histological and biochemical analysis indicated that HLJDD could protect against neurodegeneration and oxidative stress in db/db mice. Meanwhile, a total of 21 potential biomarkers with significant differences were identified between Model group and Control group using untargeted metabolomics strategy. Among them, 11 metabolites showed a trend towards the normal levels after HLJDD intervention. These metabolites principally involved in glycerophospholipid metabolism, fatty acid β-oxidation, linoleic acid metabolism, glucose metabolism and glutathione metabolism based on the metabolic pathway analysis, which were regulated in DE model mice after HLJDD intervention. Generally, the results demonstrated that HLJDD had beneficial effects on DE, which could be mediated via ameliorating the metabolic disorders.
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Affiliation(s)
- Wen-Jiao He
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China
| | - Dong-Min Cao
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China
| | - Yun-Bo Chen
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, PR China
| | - Jing-Jing Shi
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, PR China
| | - Tian Hu
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, PR China
| | - Zhi-Tong Zhang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China
| | - Tian Lan
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China
| | - Dan Tang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China.
| | - Shu-Mei Wang
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of State Administration of TCM and Engineering & Technology Research Center for Chinese Materia Medica Quality of Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China; School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China.
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Samoilova YG, Leyman OP, Tonkih OS, Matveeva MV, Kudlay DA, Oleynik OA, Zhukova NG, Ratkina KR, Fimushkina NY. Biochemical and morphometric methods for assessing cognitive impairment in patients with type 2 diabetes. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study the features of biochemical and morphometric parameters in patients with type 2 diabetes (T2D) and cognitive impairment (CI).Material and methods. The experimental group included 72 patients with CI and T2D, the control group − 20 patients with T2D and without CI. We used the Montreal Cognitive Scale (MoCA) to assess the presence of CI. We also evaluated the levels of 1,5-anhydroglucitol (1,5-AG), continuous glucose monitoring (CGM), and data of brain magnetic resonance imaging (MRI).Results. We revealed that patients with T2D and CI have high HbA1c levels, but there was no significant difference of 1,5-AG levels between the groups. In patients with CI, we also established a decrease in gray and white matter surface area, as well as subcortical structures (the hippocampus, nucleus accumbens and putamen on both sides; the amygdala and globus pallidus on the right). The severity of CI correlated with polyneuropathy severity. In patients with proliferative retinopathy, there was a decrease in the volume of the caudate nucleus, globus pallidus, putamen and nucleus accumbens. Conclusion. The study revealed that patients with T2D with CI have worse levels of carbohydrate metabolism parameters, as well as a decrease in the cortical and subcortical brain structures.
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Zhao L, Han C, Zheng Z, Xiu SL, Chan P. Risk of mini-mental state examination (MMSE) decline in the elderly with type 2 diabetes: a Chinese community-based cohort study. BMC Endocr Disord 2020; 20:129. [PMID: 32843019 PMCID: PMC7448427 DOI: 10.1186/s12902-020-00606-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the correlation of factors involved in the change of Mini-Mental State Examination (MMSE) and type 2 diabetes in the elderly. METHODS This study was a secondary analysis of a prospective cohort study. Type 2 diabetes patients aged > 55 years were recruited and assigned into three groups based on their glycated hemoglobin (HbA1c) levels: HbA1c < 7, 7% ≤ HbA1c < 8% and HbA1c ≥8%. MMSE decline was considered the endpoint. Factors related to MMSE decline were identified by univariate and multivariate regression analyses. RESULTS Altogether, 1519 subjects were included, 883 in the Low group, 333 in the Median group, and 303 in the High group. Age ≥ 75 years, education below elementary school level, not participating in seminars or consultation on healthcare, physical activity less than 30 min/day, cerebrovascular disease history, MMSE score at baseline, and HBA1c ≥8% were associated with cognitive decline by univariate and multivariate analysis. When the other factors were adjusted for, HBA1c ≥8% was independently associated with the severity of cognitive decline (β = 0.58, 95%CI:0.06-1.11, P = 0.029) and the occurrence of cognitive decline (odds ratio (OR) = 1.55, 95%CI:1.13-2.12, P = 0.007). CONCLUSIONS In elderly patients with type 2 diabetes, HbA1c ≥8% is an independent factor for cognitive decline and is also associated with the severity of the cognitive decline.
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Affiliation(s)
- Lei Zhao
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chao Han
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, 45 Changchun Road, Xicheng District, Beijing, China
| | - Zheng Zheng
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, 45 Changchun Road, Xicheng District, Beijing, China
| | - Shuang Ling Xiu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurobiology, Geriatrics, and Neurology, Xuanwu Hospital, No. 45 Changchun St., Xicheng District, Beijing, China.
- Department of Neurology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
- Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, 100053, China.
- Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing, 100053, China.
- Beijing Key Laboratory for Parkinson's Disease, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Disorders, Beijing, 100053, China.
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Potter GDM, Wood TR. The Future of Shift Work: Circadian Biology Meets Personalised Medicine and Behavioural Science. Front Nutr 2020; 7:116. [PMID: 32850937 PMCID: PMC7426458 DOI: 10.3389/fnut.2020.00116] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
Shift work is commonplace in modern societies, and shift workers are predisposed to the development of numerous chronic diseases. Disruptions to the circadian systems of shift workers are considered important contributors to the biological dysfunction these people frequently experience. Because of this, understanding how to alter shift work and zeitgeber (time cue) schedules to enhance circadian system function is likely to be key to improving the health of shift workers. While light exposure is the most important zeitgeber for the central clock in the circadian system, diet and exercise are plausible zeitgebers for circadian clocks in many tissues. We know little about how different zeitgebers interact and how to tailor zeitgeber schedules to the needs of individuals; however, in this review we share some guidelines to help shift workers adapt to their work schedules based on our current understanding of circadian biology. We focus in particular on the importance of diet timing and composition. Going forward, developments in phenotyping and "envirotyping" methods may be important to understanding how to optimise shift work. Non-invasive, multimodal, comprehensive phenotyping using multiple sources of time-stamped data may yield insights that are critical to the care of shift workers. Finally, the impact of these advances will be reduced without modifications to work environments to make it easier for shift workers to engage in behaviours conducive to their health. Integrating findings from behavioural science and ergonomics may help shift workers make healthier choices, thereby amplifying the beneficial effects of improved lifestyle prescriptions for these people.
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Affiliation(s)
| | - Thomas R Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, United States.,Division of Human Health, Performance and Resilience, Institute for Human and Machine Cognition, Pensacola, FL, United States
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Sinclair AJ, Abdelhafiz AH. Challenges and Strategies for Diabetes Management in Community-Living Older Adults. Diabetes Spectr 2020; 33:217-227. [PMID: 32848343 PMCID: PMC7428661 DOI: 10.2337/ds20-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of diabetes is increasing, especially in older people, mainly because of an increase in life expectancy. The number of comorbidities also increases with increasing age, leading to a unique diabetes phenotype in old age that includes vascular disease, physical and neuropathic complications, and mental dysfunction. These three categories of complications appear to have a synergistic effect that can lead to a vicious cycle of deterioration into disability. Early assessment and appropriate, timely interventions may delay adverse outcomes. However, this complex phenotype constitutes a great challenge for health care professionals. This article reviews the complex diabetes phenotype in old age and explores management strategies that are predominantly based on the overall functional status of patients within this heterogeneous age-group.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Droitwich Spa, UK
- Kings College, London, UK
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Diabetes and dementia - the two faces of Janus. ACTA ACUST UNITED AC 2020; 5:e186-e197. [PMID: 32832719 PMCID: PMC7433787 DOI: 10.5114/amsad.2020.97433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/18/2020] [Indexed: 01/03/2023]
Abstract
Patients with type 2 diabetes are at high risk for cognitive decline and dementia. Despite the limited data on the possible pathogenetic mechanisms, evidence suggests that cognitive decline, and thus dementia and Alzheimer’s disease, might arise from a complex interplay between type 2 diabetes and the aging brain, including decreased insulin signalling and glucose metabolism, mitochondrial dysfunction, neuroinflammation, and vascular disease. Furthermore, there is increasing interest on the effects of antidiabetic agents on cognitive decline. There are many studies showing that antidiabetic agents might have beneficial effects on the brain, mainly through inhibition of oxidative stress, inflammation, and apoptosis. In addition, experimental studies on patients with diabetes and Alzheimer’s disease have shown beneficial effects on synaptic plasticity, metabolism of amyloid-β, and microtubule-associated protein tau. Therefore, in the present review, we discuss the effects of antidiabetic agents in relation to cognitive decline, and in particular dementia and Alzheimer’s disease, in patients with type 2 diabetes.
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Han SJ. Response: Hypoglycemia and Dementia Risk in Older Patients with Type 2 Diabetes Mellitus: A Propensity-Score Matched Analysis of a Population-Based Cohort Study ( Diabetes Metab J 2020;44:125-33). Diabetes Metab J 2020; 44:360-361. [PMID: 32347031 PMCID: PMC7188975 DOI: 10.4093/dmj.2020.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Xia SS, Xia WL, Huang JJ, Zou HJ, Tao J, Yang Y. The factors contributing to cognitive dysfunction in type 2 diabetic patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:104. [PMID: 32175397 DOI: 10.21037/atm.2019.12.113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Backgrounds The aim of the research was to investigate the factors contributing to cognitive dysfunction in type 2 diabetic patients, to distinguish the complex relationship between diabetic retinopathy (DR) and different cognitive status. Methods Two hundred and ninety-seven type 2 diabetes mellitus (T2DM) patients were enrolled in our study. We adopted the Clinical Dementia Rating (CDR), Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) to evaluate the cognitive function. Firstly, cognition status was classified into dementia and non-dementia according to MMSE and CDR. Patients with non-dementia were further classified into mild cognitive impairment (MCI) and normal cognition status based on MOCA. The factors contributing to cognitive dysfunction were analyzed. Results Among the 297 T2DM subjects, 47 were enrolled in the dementia group and 174 in the MCI group according to a battery of cognitive function tests, presenting a prevalence of 15.8% and 58.6% respectively. After adjustment for age, sex, and education level, waist circumference and DR were risk factors for dementia (OR: 1.057, P=0.011; OR: 2.197, P=0.040). Low-density lipoprotein cholesterol (LDL-C) was a risk factor for MCI (OR: 1.635, P=0.047), while age at T2DM onset and moderate drinking were protective factors for MCI (OR: 0.936, P=0.044; OR: 0.289, P=0.004). Conclusions MCI is common in T2DM patients. Waist circumference and DR are risk factors of dementia, LDL-C is a risk factor for MCI, and moderate drinking and age at T2DM onset are protective factors for MCI. DR is unrelated to MCI in T2DM.
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Affiliation(s)
- San-Shan Xia
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wen-Lin Xia
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jiao-Jiao Huang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua-Jie Zou
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Tao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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