1
|
Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
Collapse
Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
2
|
László BR, Hormay E, Szabó I, Mintál K, Nagy B, László K, Péczely L, Ollmann T, Lénárd L, Karádi Z. Disturbance of taste reactivity and other behavioral alterations after bilateral interleukin-1β microinjection into the cingulate cortex of the rat. Behav Brain Res 2020; 383:112537. [PMID: 32032742 DOI: 10.1016/j.bbr.2020.112537] [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: 10/29/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
The anterior cingulate cortex (ACC), is known to be intimately involved in food-related motivational processes and their behavioral organization, primarily by evaluating hedonic properties of the relevant stimuli. In the present study, the involvement of cingulate cortical interleukin-1β (IL-1β) mediated mechanisms in a) gustation associated facial and somato-motor behavioral patterns of Wistar rats were examined in taste reactivity test (TR). In addition, b) conditioned taste aversion (CTA) paradigm was performed to investigate the role of these cytokine mechanisms in taste sensation associated learning processes, c) the general locomotor activity of the animals was observed in open field test (OPF), and d) the potentially negative reinforcing effect of IL-1β was examined in conditioned place preference test (CPP). During the TR test, species specific behavioral patterns in response to the five basic tastes were analyzed. Response rates of ingestive and aversive patterns of the cytokine treated and the control groups differed significantly in case of the weaker bitter (QHCl, 0.03 mM), and the stronger umami (MSG, 0.5 M) tastes. IL-1β itself did not elicit CTA, it did not interfere with the acquisition of LiCl induced CTA, and it also failed to cause place preference or aversion in the CPP test. In the OPF paradigm, however, significant differences were found between the cytokine treated and the control groups in the rearing and grooming, the number of crossings, and in the distance moved. Our results indicate the involvement of cingulate cortical IL-1β mechanisms in the control of taste perception and other relevant behavioral processes.
Collapse
Affiliation(s)
- Bettina Réka László
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
| | - Edina Hormay
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - István Szabó
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Kitti Mintál
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Bernadett Nagy
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Kristóf László
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - László Péczely
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Tamás Ollmann
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - László Lénárd
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; Molecular Neuroendocrinology and Neurophysiology Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zoltán Karádi
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; Molecular Neuroendocrinology and Neurophysiology Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| |
Collapse
|
3
|
Karvani M, Simos P, Stavrakaki S, Kapoukranidou D. Neurocognitive impairment in type 2 diabetes mellitus. Hormones (Athens) 2019; 18:523-534. [PMID: 31522366 DOI: 10.1007/s42000-019-00128-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/05/2019] [Indexed: 12/24/2022]
Abstract
There is emerging evidence that cognitive impairment could be a diabetes mellitus-related complication. It has been suggested that diabetic people are at increased risk of cognitive decline, since the metabolic and vascular disturbances of the disease affect brain function. Additionally, prolonged exposure to olther potential detrimental factors leads to irreversible cognitive decrements over time due to the aging process. Neurocognitive impairment signifies decreased performance in cognitive domains such as verbal and nonverbal memory, both immediate and delayed memory, executive function, attention, visuospatial and psychomotor performance, information processing speed, semantic knowledge, and language abilities. The aim of the present article is to review the existing literature on the issue of the neurocognitive decline in type 2 diabetes. A literature search of databases was performed, using as keywords "diabetes" and "cognitive impairment," and the reference list of papers so identified were examined, with only English language papers being used. Understanding and preventing diabetes-associated cognitive deficits remains a key priority for future research. It is important to ascertain whether interventions to delay diabetes onset or better control of established disease could prevent some of its adverse effects on cognitive skills.
Collapse
Affiliation(s)
- Marianna Karvani
- Department of Physiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - P Simos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Herakleion, Crete, Greece
| | - S Stavrakaki
- Department of Italian Language and Literature, School of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Kapoukranidou
- Department of Physiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Hormay E, László B, Szabó I, Ollmann T, Nagy B, Péczely L, Mintál K, Karádi Z. The effect of loss of the glucose-monitoring neurons in the anterior cingulate cortex: Physiologic challenges induce complex feeding-metabolic alterations after local streptozotocin microinjection in rats. Neurosci Res 2019; 149:50-60. [PMID: 30685493 DOI: 10.1016/j.neures.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
The anterior cingulate cortex (ACC) is interrelated to limbic structures, parts of the central glucose-monitoring (GM) network. GM neurons, postulated to exist here, are hypothesised to participate in regulatory functions, such as the central control of feeding and metabolism. In the present experiments, GM neurons were identified and examined in the ACC by means of the multibarreled microelectrophoretic technique. After bilateral ACC microinjection of streptozotocin (STZ), glucose tolerance tests (GTTs), and determination of relevant plasma metabolite concentrations were performed. Body weights were measured at regular time points during the GTT experiment. Ten percent of the neurons - 30 of 282 recorded cells - responded to the administration of D-glucose, thus, declared to be the GM units. The peak values and dynamics of the GTT blood glucose curves, the plasma metabolite concentrations, and the weight gain were pathologically altered in the STZ treated animals. Our recording experiments revealed the existence of GM neurons in the anterior cingulate cortex. STZ induced selective destruction of these chemosensory cells resulted in feeding and metabolic alterations. The present findings indicate distinguished significance of the cingulate cortical GM neurons in adaptive processes of maintenance of the homeostatic balance.
Collapse
Affiliation(s)
- Edina Hormay
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary.
| | - Bettina László
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - István Szabó
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - Tamás Ollmann
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - Bernadett Nagy
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - László Péczely
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - Kitti Mintál
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary
| | - Zoltán Karádi
- Institute of Physiology, Pécs University, Medical School, Pécs, Hungary; Neuroscience Centre, Pécs University, Pécs, Hungary; Molecular Neuroendocrinology and Neurophysiology Research Group, Szentágothai Research Center, Pécs University, Pécs, Hungary
| |
Collapse
|
5
|
Gejl M, Gjedde A, Brock B, Møller A, van Duinkerken E, Haahr HL, Hansen CT, Chu PL, Stender-Petersen KL, Rungby J. Effects of hypoglycaemia on working memory and regional cerebral blood flow in type 1 diabetes: a randomised, crossover trial. Diabetologia 2018; 61:551-561. [PMID: 29188338 PMCID: PMC6448973 DOI: 10.1007/s00125-017-4502-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 01/31/2023]
Abstract
AIMS/HYPOTHESIS The aim of this randomised, crossover trial was to compare cognitive functioning and associated brain activation patterns during hypoglycaemia (plasma glucose [PG] just below 3.1 mmol/l) and euglycaemia in individuals with type 1 diabetes mellitus. METHODS In this patient-blinded, crossover study, 26 participants with type 1 diabetes mellitus attended two randomised experimental visits: one hypoglycaemic clamp (PG 2.8 ± 0.2 mmol/l, approximate duration 55 min) and one euglycaemic clamp (PG 5.5 mmol/l ± 10%). PG levels were maintained by hyperinsulinaemic glucose clamping. Cognitive functioning was assessed during hypoglycaemia and euglycaemia conditions using a modified version of the digit symbol substitution test (mDSST) and control DSST (cDSST). Simultaneously, regional cerebral blood flow (rCBF) was measured in pre-specified brain regions by six H215O-positron emission tomographies (PET) per session. RESULTS Working memory was impaired during hypoglycaemia as indicated by a statistically significantly lower mDSST score (estimated treatment difference [ETD] -0.63 [95% CI -1.13, -0.14], p = 0.014) and a statistically significantly longer response time (ETD 2.86 s [7%] [95% CI 0.67, 5.05], p = 0.013) compared with euglycaemia. During hypoglycaemia, mDSST task performance was associated with increased activity in the frontal lobe regions, superior parietal lobe and thalamus, and decreased activity in the temporal lobe regions (p < 0.05). Working memory activation (mDSST - cDSST) statistically significantly increased blood flow in the striatum during hypoglycaemia (ETD 0.0374% [95% CI 0.0157, 0.0590], p = 0.002). CONCLUSIONS/INTERPRETATION During hypoglycaemia (mean PG 2.9 mmol/l), working memory performance was impaired. Altered performance was associated with significantly increased blood flow in the striatum, a part of the basal ganglia implicated in regulating motor functions, memory, language and emotion. TRIAL REGISTRATION NCT01789593, clinicaltrials.gov FUNDING: This study was funded by Novo Nordisk.
Collapse
Affiliation(s)
- Michael Gejl
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, Building 1242, 8000, Aarhus C, Denmark.
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Albert Gjedde
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Birgitte Brock
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Arne Møller
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, Building 1242, 8000, Aarhus C, Denmark
- PET-Center, Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Eelco van Duinkerken
- VU University Medical Centre, Amsterdam, the Netherlands
- Pontifícia Universidade Católica, Rio de Janeiro, Brazil
| | | | | | | | | | - Jørgen Rungby
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, Building 1242, 8000, Aarhus C, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology IC, Bispebjerg University Hospital, Bispebjerg, Copenhagen, Denmark
| |
Collapse
|
6
|
Csetényi B, Hormay E, Szabó I, Takács G, Nagy B, László K, Karádi Z. Food and water intake, body temperature and metabolic consequences of interleukin-1β microinjection into the cingulate cortex of the rat. Behav Brain Res 2017; 331:115-122. [PMID: 28527691 DOI: 10.1016/j.bbr.2017.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/30/2022]
Abstract
In order to elucidate whether cytokine mechanisms of the cingulate cortex (cctx) are important in the central regulation of homeostasis, in the present study, feeding-metabolic effects of direct bilateral microinjection of interleukin-1β (IL-1β) into the cctx of the rat have been investigated. Short- (2h), medium (12h) and long-term (24h) food and water intakes and body temperature were measured after the intracerebral administration of this primary cytokine or vehicle solution, with or without paracetamol pretreatment. The effect of IL-1β on the blood glucose level of animals was examined in glucose tolerance test (GTT), and concentrations of relevant plasma metabolites (total cholesterol, HDL, LDH, triglycerides, uric acid) were additionally also determined following the above microinjections. In contrast to causing no major alteration in the food and water intakes, the cytokine treatment evoked significant increase in the body temperature of the rats. Prostaglandin-mediated mechanisms were shown to have important role in the mode of this action of IL-1β, since paracetamol pretreatment partially prevented the development of the above mentioned hyperthermia. In the GTT, no considerable difference was observed between the blood glucose levels of the cytokine treated and control animals. Following IL-1β microinjection, however, significant decrease of HDL and total cholesterol was found. Our present findings indicate that elucidating the IL-1β mediated homeostatic control mechanisms in the cingulate cortex may lead to the better understanding not only the regulatory entities of the healthy organism but also those found in obesity, diabetes mellitus and other worldwide rapidly spreading feeding-metabolic disorders.
Collapse
Affiliation(s)
- B Csetényi
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary.
| | - E Hormay
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - I Szabó
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - G Takács
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - B Nagy
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - K László
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - Z Karádi
- Institute of Physiology, University of Pécs, Medical School, Pécs, Hungary; Centre for Neuroscience, University of Pécs, Pécs, Hungary; Molecular Neuroendocrinology and Neurophysiology Research Group, Szentágothai Research Center, University of Pécs, Pécs, Hungary
| |
Collapse
|
7
|
Kristensen PL, Pedersen-Bjergaard U, Due-Andersen R, Høi-Hansen T, Grimmeshave L, Lyssenko V, Groop L, Holst JJ, Vaag AA, Thorsteinsson B. Impact of the TCF7L2 genotype on risk of hypoglycaemia and glucagon secretion during hypoglycaemia. Endocr Connect 2016; 5:53-60. [PMID: 27758844 PMCID: PMC5097143 DOI: 10.1530/ec-16-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In healthy carriers of the T allele of the transcription factor 7-like 2 (TCF7L2), fasting plasma glucagon concentrations are lower compared with those with the C allele. We hypothesised that presence of the T allele is associated with a diminished glucagon response during hypoglycaemia and a higher frequency of severe hypoglycaemia (SH) in type 1 diabetes (T1DM). MATERIAL AND METHODS This is a post hoc study of an earlier prospective observational study of SH and four mechanistic studies of physiological responses to hypoglycaemia. 269 patients with T1DM were followed in a one-year observational study. A log-linear negative binomial model was applied with events of SH as dependent variable and TCF7L2 alleles as explanatory variable. In four experimental studies including 65 people, TCF7L2 genotyping was done and plasma glucagon concentration during experimental hypoglycaemia was determined. RESULTS Incidences of SH were TT 0.54, TC 0.98 and CC 1.01 episodes per patient-year with no significant difference between groups. During experimental hypoglycaemia, the TCF7L2 polymorphism did not influence glucagon secretion. DISCUSSION Patients with T1DM carrying the T allele of the TCF7L2 polymorphism do not exhibit diminished glucagon response during hypoglycaemia and are not at increased risk of severe hypoglycaemia compared with carriers of the C allele.
Collapse
Affiliation(s)
- Peter L Kristensen
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
- Faculty of Health and Medical SciencesUniversity of Copenhagen, Copenhagen, Denmark
| | - Rikke Due-Andersen
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
- Lægerne på EllemarksvejKøge, Denmark
| | - Thomas Høi-Hansen
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
- Department of CardiologyHerlev-Gentofte University Hospital, Herlev, Denmark
| | - Lise Grimmeshave
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
- Novo Nordisk A/SSøborg, Denmark
| | - Valeriya Lyssenko
- Steno Diabetes CenterGentofte, Denmark
- Lund University Diabetes CentreSkåne University Hospital, Malmø, Sweden
| | - Leif Groop
- Lund University Diabetes CentreSkåne University Hospital, Malmø, Sweden
- Finnish Institute for Molecular Medicine (FIMM)Helsinki University, Helsinki, Finland
| | - Jens J Holst
- Faculty of Health and Medical SciencesUniversity of Copenhagen, Copenhagen, Denmark
- Department of Biomedical SciencesNNF Center for Basic Metabolic Research, The Panum Institute, Copenhagen, Denmark
| | - Allan A Vaag
- Faculty of Health and Medical SciencesUniversity of Copenhagen, Copenhagen, Denmark
- Department of EndocrinologyCopenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Birger Thorsteinsson
- Department of CardiologyNephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
- Faculty of Health and Medical SciencesUniversity of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Kim C, Sohn JH, Jang MU, Kim SH, Choi MG, Ryu OH, Lee S, Choi HC. Association between Visit-to-Visit Glucose Variability and Cognitive Function in Aged Type 2 Diabetic Patients: A Cross-Sectional Study. PLoS One 2015; 10:e0132118. [PMID: 26132234 PMCID: PMC4488839 DOI: 10.1371/journal.pone.0132118] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/10/2015] [Indexed: 01/21/2023] Open
Abstract
Background and Purpose Diabetes is associated with cognitive decline as well as the development of dementia. Although mean blood glucose levels are typically used to assess the status of diabetic patients, glucose variability is also involved in the manifestation of macro- and microvascular complications in this population. Thus, the present study sought to determine whether visit-to-visit glucose variability contributes to cognitive decline in patients with type 2 diabetes. Methods The present study assessed 68 patients with type 2 diabetes using several validated neuropsychological measures. All patients had no cerebrovascular disease, history of hypoglycemia, psychiatric conditions, or other medical illnesses. Standard deviations (SDs) and coefficients of variance (CVs) of the patients’ blood glucose (after fasting and 2 hours postprandial; FBS and PP2), and glycated hemoglobin (HbA1c) values were used as indices of glucose variability. The cognitive outcome parameters were transformed with z-scores and entered into a multiple linear regression model that included educational status, age, sex, vascular risk factors, and mean glucose parameters as covariates. Results The mean age of the total patient population was 70.9 years; 46 (67.6%) of the patients were men, and the median follow-up duration at our endocrinology outpatient clinic was 4.8 years. The mean FBS and PP2 glucose levels of the patients were 132 mg/dL and 199 mg/dL, respectively, and the mean HbA1c level was 8.0%. A univariable analysis revealed that only the PP2 value was associated with the Mini-Mental State Examination (MMSE) score, and multivariable analysis revealed that a high SD and/or CV for PP2 glucose were associated with low scores on the Rey Complex Figure Copy test and/or the Verbal Learning Test. Additionally, a high SD and a higher CV for HbA1c level were significantly associated with low MMSE and Digit Span test scores even after adjusting for mean HbA1c values. Conclusions The present data indicate that a greater degree of visit-to-visit glucose variability influenced specific types of cognitive function in type 2 diabetic patients independently of mean blood glucose levels. Future studies should focus on whether reductions in glycemic variability will improve the cognitive decline observed in type 2 diabetic patients.
Collapse
Affiliation(s)
- Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Jong-Hee Sohn
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Min Uk Jang
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Sung-Hun Kim
- Department of Neurology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Moon-Gi Choi
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Sungwha Lee
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Hui-Chul Choi
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea
- * E-mail:
| |
Collapse
|
9
|
Liao Y, Lei M, Huang H, Wang C, Duan J, Li H, Liu X. The time course of altered brain activity during 7-day simulated microgravity. Front Behav Neurosci 2015; 9:124. [PMID: 26029071 PMCID: PMC4428138 DOI: 10.3389/fnbeh.2015.00124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/29/2015] [Indexed: 11/21/2022] Open
Abstract
Microgravity causes multiple changes in physical and mental levels in humans, which can induce performance deficiency among astronauts. Studying the variations in brain activity that occur during microgravity would help astronauts to deal with these changes. In the current study, resting-state functional magnetic resonance imaging (rs-fMRI) was used to observe the variations in brain activity during a 7-day head down tilt (HDT) bed rest, which is a common and reliable model for simulated microgravity. The amplitudes of low frequency fluctuation (ALFF) of twenty subjects were recorded pre-head down tilt (pre-HDT), during a bed rest period (HDT0), and then each day in the HDT period (HDT1–HDT7). One-way analysis of variance (ANOVA) of the ALFF values over these 8 days was used to test the variation across time period (p < 0.05, corrected). Compared to HDT0, subjects presented lower ALFF values in the posterior cingulate cortex (PCC) and higher ALFF values in the anterior cingulate cortex (ACC) during the HDT period, which may partially account for the lack of cognitive flexibility and alterations in autonomic nervous system seen among astronauts in microgravity. Additionally, the observed improvement in function in CPL during the HDT period may play a compensatory role to the functional decline in the paracentral lobule to sustain normal levels of fine motor control for astronauts in a microgravity environment. Above all, those floating brain activities during 7 days of simulated microgravity may indicate that the brain self-adapts to help astronauts adjust to the multiple negative stressors encountered in a microgravity environment.
Collapse
Affiliation(s)
- Yang Liao
- Department of Medical Psychology, Fourth Military Medical University Xi'an, Shaanxi, China
| | - Meiying Lei
- Mental Health Center, 303 Hospital of PLA Nanning, Guangxi, China
| | - Haibo Huang
- Department of Radiology, 303 Hospital of PLA Nanning, Guangxi, China
| | - Chuang Wang
- Mental Health Center, 303 Hospital of PLA Nanning, Guangxi, China
| | - Jiaobo Duan
- Department of Medical Psychology, Fourth Military Medical University Xi'an, Shaanxi, China
| | - Hongzheng Li
- Mental Health Center, 303 Hospital of PLA Nanning, Guangxi, China
| | - Xufeng Liu
- Department of Medical Psychology, Fourth Military Medical University Xi'an, Shaanxi, China
| |
Collapse
|
10
|
Weise CM, Thiyyagura P, Reiman EM, Chen K, Krakoff J. A potential role for the midbrain in integrating fat-free mass determined energy needs: An H2 (15) O PET study. Hum Brain Mapp 2015; 36:2406-15. [PMID: 25766283 DOI: 10.1002/hbm.22780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 12/30/2022] Open
Abstract
Little is known on how sensing of energy needs is centrally represented, integrated, and translated into the behavioral aspects of energy homeostasis. Fat free mass (FFM) is the major determinant of energy expenditure. We investigated how interindividual variances in FFM relate to neuronal activity in humans. Healthy adults (n = 64, 21F/43M; age 31.3 ± 9.1y; percentage of body fat [PFAT] 25.6 ± 10.7%; BMI 30.4 ± 9) underwent a 36h fast and subsequent H(2) (15) O positron emission tomographic (PET) measurement of regional cerebral blood flow (rCBF). Multiple variable regression analysis revealed significant associations of FFM with rCBF within the midbrain [including parts of the periaqueductal gray (PAG), ventral tegmental area (VTA), thalamic and hypothalamic regions], the bilateral parahippocampal region, left anterior cingulate, left insular cortex, right cerebellum, and distinct regions within the temporal and occipital cortex. In contrast, no significant associations were found for fat mass (FM). We investigated the potential functional-anatomical link between FFM and central regulation of food intake by performing a conjunction analysis of FFM and the perceived hunger feelings. This showed a significant overlap within the midbrain PAG. Mediation analysis demonstrated a significant indirect effect of FFM on hunger with PAG rCBF as mediator. Most regions we found to be associated with FFM form part in ascending homeostatic pathways and cortical circuitries implicated in the regulation of basic bodily functions indicating a potential role of these central networks in the integration of FFM determined energy needs.
Collapse
Affiliation(s)
- Christopher M Weise
- Obesity and Diabetes Clinical Research Section, NIDDK-NIH, DHHS, Phoenix, Arizona; Department of Neurology, University of Leipzig, Germany
| | | | | | | | | |
Collapse
|
11
|
Localization of function in anterior cingulate cortex: From psychosurgery to functional neuroimaging. Neurosci Biobehav Rev 2013; 37:340-8. [DOI: 10.1016/j.neubiorev.2013.01.002] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 12/10/2012] [Accepted: 01/03/2013] [Indexed: 12/19/2022]
|
12
|
Weston C. Another major function of the anterior cingulate cortex: The representation of requirements. Neurosci Biobehav Rev 2012; 36:90-110. [DOI: 10.1016/j.neubiorev.2011.04.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/01/2011] [Accepted: 04/20/2011] [Indexed: 01/18/2023]
|
13
|
Anderson BJ, Greenwood SJ, McCloskey D. Exercise as an intervention for the age-related decline in neural metabolic support. Front Aging Neurosci 2010; 2. [PMID: 20802804 PMCID: PMC2928710 DOI: 10.3389/fnagi.2010.00030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 06/27/2010] [Indexed: 12/24/2022] Open
Abstract
To identify interventions for brain aging, we must first identify the processes in which we hope to intervene. Brain aging is a period of decreasing functional capacity and increasing vulnerability, which reflect a reduction in morphological organization and perhaps degeneration. Since life is ultimately dependent upon the ability to maintain cellular organization through metabolism, this review explores evidence for a decline in neural metabolic support during aging, which includes a reduction in whole brain cerebral blood flow, and cellular metabolic capacity. Capillary density may also decrease with age, although the results are less clear. Exercise may be a highly effective intervention for brain aging, because it improves the cardiovascular system as a whole, and increases regional capillary density and neuronal metabolic capacity. Although the evidence is strongest for motor regions, more work may yield additional evidence for exercise-related improvement in metabolic support in non-motor regions. The protective effects of exercise may be specific to brain region and the type of insult. For example, exercise protects striatal cells from ischemia, but it produces mixed results after hippocampal seizures. Exercise can improve metabolic support and bioenergetic capacity in adult animals, but it remains to be determined whether it has similar effects in aging animals. What is clear is that exercise can influence the multiple levels of support necessary for maintaining optimal neuronal function, which is unique among proposed interventions for aging.
Collapse
Affiliation(s)
- Brenda J Anderson
- Department of Psychology and Program Neuroscience, Stony Brook University Stony Brook, NY, USA
| | | | | |
Collapse
|
14
|
Bie-Olsen LG, Pedersen-Bjergaard U, Kjær TW, Lonsdale MN, Law I, Thorsteinsson B. Differences in cortical and pituitary activity in response to hypoglycaemia and cognitive testing in healthy men with different basal activity of the renin-angiotensin system. J Renin Angiotensin Aldosterone Syst 2010; 11:173-9. [DOI: 10.1177/1470320310364182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. High renin-angiotensin system (RAS) activity has been associated with a high risk of severe hypoglycaemia in patients with type 1 diabetes and with cognitive deterioration during experimental hypoglycaemia in healthy subjects. The aim of this study was to describe possible differences in cerebral activity during hypoglycaemia and cognitive testing in two groups of healthy men with different basal RAS activity. Methods. Ten healthy men with high RAS activity and 10 with low activity underwent six oxygen-15-labelled water positron emission tomography scans: twice during normoglycaemia, twice during insulin-induced hypoglycaemia and twice during post-hypoglycaemia. During the scans, the subjects performed a computer-based reaction time test. Results. Occipital areas were consistently more activated in the low RAS group than in the high RAS group throughout all three conditions. During normoglycaemia, the frontal region was more activated in the low RAS group than in the high RAS group. During hypoglycaemia, the high RAS group was more activated in the pituitary gland than the low RAS group. Conclusion. Basal RAS activity influenced cerebral activity. Low RAS was associated with more pronounced cortical activation in all glycaemic conditions. High RAS was associated with pituitary activation during hypoglycaemia and post-hypoglycaemia, and this was associated with a greater growth hormone response.
Collapse
Affiliation(s)
- Lise G Bie-Olsen
- Endocrinology Section, Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark,
| | - Ulrik Pedersen-Bjergaard
- Endocrinology Section, Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
| | - Troels W Kjær
- Clinic of Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Markus N Lonsdale
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ian Law
- PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - Birger Thorsteinsson
- Endocrinology Section, Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
| |
Collapse
|
15
|
Paulson OB, Hasselbalch SG, Rostrup E, Knudsen GM, Pelligrino D. Cerebral blood flow response to functional activation. J Cereb Blood Flow Metab 2010; 30:2-14. [PMID: 19738630 PMCID: PMC2872188 DOI: 10.1038/jcbfm.2009.188] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cerebral blood flow (CBF) and cerebral metabolic rate are normally coupled, that is an increase in metabolic demand will lead to an increase in flow. However, during functional activation, CBF and glucose metabolism remain coupled as they increase in proportion, whereas oxygen metabolism only increases to a minor degree-the so-called uncoupling of CBF and oxidative metabolism. Several studies have dealt with these issues, and theories have been forwarded regarding the underlying mechanisms. Some reports have speculated about the existence of a potentially deficient oxygen supply to the tissue most distant from the capillaries, whereas other studies point to a shift toward a higher degree of non-oxidative glucose consumption during activation. In this review, we argue that the key mechanism responsible for the regional CBF (rCBF) increase during functional activation is a tight coupling between rCBF and glucose metabolism. We assert that uncoupling of rCBF and oxidative metabolism is a consequence of a less pronounced increase in oxygen consumption. On the basis of earlier studies, we take into consideration the functional recruitment of capillaries and attempt to accommodate the cerebral tissue's increased demand for glucose supply during neural activation with recent evidence supporting a key function for astrocytes in rCBF regulation.
Collapse
Affiliation(s)
- Olaf B Paulson
- Neurobiology Research Unit 9201, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
16
|
Association between regional cerebral blood flow during hypoglycemia and genetic and phenotypic traits of the renin-angiotensin system. J Cereb Blood Flow Metab 2009; 29:1790-5. [PMID: 19584889 DOI: 10.1038/jcbfm.2009.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of severe hypoglycemia in patients with type I diabetes and high basal activity in the renin-angiotensin system (RAS) is significantly higher than in patients with low basal RAS activity. In healthy men, we tested the hypothesis that differences in spontaneous RAS activity are associated with differences in cerebral activity responses during mild hypoglycemia. A total of 10 healthy men with high and 10 with low spontaneous RAS activity were selected. An H(2)(15)O-PET (H(2)(15)O-positron emission tomography) study was conducted with a series of six scans, i.e., two during normoglycemia, two during hypoglycemia, and two after hypoglycemia. The mean plasma glucose concentration was similar in both the groups (i.e., 2.1 mmol/L (s.d.: 0.4) in the low RAS group and 2.2 mmol/L (s.d.: 0.4) in the high RAS group (P=0.47)). The high RAS group has lower cerebral activity in the frontal area and a higher cerebral activity in the entorhinal area that expanded to include the parahippocampal gyrus after hypoglycemia. Our findings suggest that the high RAS group to a lesser extent than the low RAS group activates areas involving executive function that may explain the correlation between high basal RAS activity and risk of severe hypoglycemia in type I diabetes.
Collapse
|