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Cao F, Yang F, Li J, Guo W, Zhang C, Gao F, Sun X, Zhou Y, Zhang W. The relationship between diabetes and the dementia risk: a meta-analysis. Diabetol Metab Syndr 2024; 16:101. [PMID: 38745237 PMCID: PMC11092065 DOI: 10.1186/s13098-024-01346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The link between diabetes and dementia risk is not well understood. This study evaluates the factors linking diabetes to dementia onset, providing guidance for preventing dementia in diabetic patients. METHODS This analysis utilized databases such as PubMed, Embase, Web of Science, and the Cochrane Library to review literature from January 31, 2012, to March 5, 2023. Articles were rigorously assessed using specific inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. Data analysis was performed with STATA 15.0. RESULTS The study analyzed 15 articles, covering 10,103,868 patients, with 8,821,516 diagnosed with diabetes. The meta-analysis reveals a substantial association between diabetes and an increased risk of dementia [RR: 1.59, 95%CI (1.40-1.80), P < 0.01, I²=96.4%]. A diabetes duration of less than five years is linked to a higher dementia risk [RR: 1.29, 95%CI (1.20-1.39), P < 0.01, I²=92.6%]. Additionally, hypoglycemia significantly raises dementia risk [RR: 1.56, 95%CI (1.13-2.16), P < 0.01, I²=51.5%]. Analyses of blood sugar control, glycated hemoglobin, and fasting blood sugar indicated no significant effects on the onset of dementia. CONCLUSION Diabetes notably increases dementia risk, particularly where diabetes duration is under five years or hypoglycemia is present. REGISTRATION The research protocol was registered with PROSPERO and assigned the registration number CRD42023394942.
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Affiliation(s)
- Fang Cao
- School of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Fushuang Yang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Jian Li
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Wei Guo
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Chongheng Zhang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Fa Gao
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Xinxin Sun
- Department of Nutrition, Chinese People's Armed Police Force Medical Characteristic Center, Tianjin, 300162, China
| | - Yi Zhou
- Department of Geriatrics, Baotou Mengshi Hospital of Traditional Chinese Medicine, Baotou, 014000, China
| | - Wenfeng Zhang
- School of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, 130117, China.
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Niu X, Chang J, Corrada MM, Bullock A, Winchester B, Manson SM, O’Connell J, Jiang L. The Relationship between All-Cause Dementia and Acute Diabetes Complications among American Indian and Alaska Native Peoples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:496. [PMID: 38673407 PMCID: PMC11049920 DOI: 10.3390/ijerph21040496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND American Indian and Alaska Native people (AI/AN) bear a disproportionate burden of diabetes. Growing evidence shows significant associations between several acute diabetes complications and dementia among diabetes patients. However, little is known about these relationships among AI/AN adults. Here, we aim to investigate these associations among AI/AN adults. METHODS This cross-sectional study extracted data from the Indian Health Service's (IHS) National Data Warehouse and related administrative databases. A total of 29,337 IHS actual users with diabetes who were 45+ years old during fiscal year 2013 were included. All-cause dementia and diabetes complications were identified using ICD-9 diagnostic codes. Negative binomial regression models were used to evaluate the associations of interest. RESULTS Nearly 3% of AI/AN diabetes patients had a dementia diagnosis. After controlling for covariates, dementia was associated with a 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50-2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11-2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53-2.41). CONCLUSIONS AI/AN diabetes patients with dementia suffered from considerably higher rates of acute diabetes complications than their counterparts without dementia. The clinical management of patients with comorbid diabetes and dementia is particularly challenging and may require individualized treatment approaches.
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Affiliation(s)
- Xiaoyi Niu
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
| | - Jenny Chang
- Department of Medicine, University of California Irvine, Irvine, CA 92697, USA;
| | - Maria M. Corrada
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
- Department of Neurology, School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Ann Bullock
- Formerly with the Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD 20857, USA;
| | | | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Joan O’Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Luohua Jiang
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
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Gao R, Zhan M, Ke S, Wu K, He G, Qi L, Liu X, Liu X, Wang L, Liu L. Potential risk factors for mild cognitive impairment among patients with type 2 diabetes experiencing hypoglycemia. Diabetes Res Clin Pract 2024; 207:111036. [PMID: 38049036 DOI: 10.1016/j.diabres.2023.111036] [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: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
AIMS This study examined the association between hypoglycemia and mild cognitive impairment (MCI) among patients with type 2 diabetes mellitus (T2DM) and identified risk factors for MCI in patients with hypoglycemia. METHODS In this retrospective study, 328 patients with T2DM were screened in 2019 and followed up in 2022. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). The diagnosis of MCI was based on established criteria. Risk ratio (RR) with 95 % confidence intervals (CI) was calculated to estimate the risk of MCI. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for MCI in those with hypoglycemia. RESULTS Patients with hypoglycemia had lower cognitive performance 3 years later. The RR of MCI was 2.221 (95 % CI 1.269-3.885). Multivariate logistic analysis showed that low grip strength, existing diabetic retinopathy (DR), and multiple hypoglycemia episodes were associated with higher odds of MCI in patients with hypoglycemia (adjusted odds ratio [OR] 0.909 [95 % CI 0.859-0.963]), 3.078 [95 % CI 1.158-12.358], and 4.642 [95 % CI 1.284-16.776], respectively, all P < 0.05). CONCLUSIONS Hypoglycemia increased MCI risk among patients with T2DM. Low grip strength, DR, and multiple hypoglycemia episodes may be potential risk factors for hypoglycemia-associated MCI.
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Affiliation(s)
- Ruonan Gao
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Menglan Zhan
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sujie Ke
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kejun Wu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guanlian He
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liqin Qi
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoying Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaohong Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lijing Wang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Libin Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China.
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Gómez-Guijarro MD, Álvarez-Bueno C, Saz-Lara A, Sequí-Domínguez I, Lucerón-Lucas-Torres M, Cavero-Redondo I. Association between severe hypoglycaemia and risk of dementia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2023; 39:e3610. [PMID: 36649373 DOI: 10.1002/dmrr.3610] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
The aim of this systematic review was to analyse whether there is an association between severe hypoglycaemia and the incidence of dementia in patients with type 2 diabetes mellitus. We systematically searched the MEDLINE, Scopus, and Cochrane databases from their inception until September 2022 for observational studies on the association between hypoglycaemia and the risk of dementia. The DerSimonian and Laird method was used to compute a pooled estimate of the risk for such association. Risk ratio (RR) and its respective 95% confidence interval (95% CI). Two analyses were performed to estimate the risk of dementia: (i) any hypoglycaemia versus no hypoglycaemia and (ii) a dose-response analysis for one, two, or more than three hypoglycemic events versus no hypoglycaemia. PROSPERO registration number CRD42020219200. Seven studies were included. The pooled RR for the association of severe hypoglycaemia and risk of dementia was 1.47 (95% CI: 1.24-1.74). When the dose-response trend was analysed, the pooled RR for the risk of dementia was increased according to the hypoglycaemia events as follows: 1.29 (95% CI: 1.15-1.44) for one hypoglycemic event; 1.68 (95% CI: 1.38-2.04) for two hypoglycemic events; and 1.99 (95% CI: 1.48-2.68) for three or more hypoglycemic events. Our study demonstrates a 54% higher risk of dementia among people who suffer a hypoglycaemia event compared to nonhypoglycaemia. Considering our results and the prevalence of people suffering from diabetes mellitus, health education for both newly diagnosed and already diagnosed people could be a useful tool for glycaemic control, thus avoiding hypoglycaemic events.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
- Universidad Politécnica y artística del Paraguay, Asunción, Paraguay
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
| | - Irene Sequí-Domínguez
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
| | | | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Associations of Mid- and Late-Life Severe Hypoglycemic Episodes With Incident Dementia Among Patients With Type 2 Diabetes: A Population-Based Cohort Study. Diabetes Care 2023; 46:331-340. [PMID: 36516080 DOI: 10.2337/dc22-1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Severe hypoglycemia is associated with an increased risk of dementia. We examined if the association is consistently present in mid- and late-life hypoglycemia. RESEARCH DESIGN AND METHODS Using health care data from Population Data BC, we created a base cohort of patients age ≥40 years with incident type 2 diabetes. Exposure was the first occurrence of severe hypoglycemia (hospitalization or physician visit). We assessed exposure versus no exposure in mid- (age 45-64 years) and late-life (age 65-84 years) cohorts. Index date was the later of the 45th birthday (midlife cohort), 65th birthday (late-life cohort), or diabetes diagnosis. Those with hypoglycemia or dementia before the index date were excluded. Patients were followed from index date until dementia diagnosis, death, emigration, or 31 December 2018. Exposure was modeled as time dependent. We adjusted for confounding using propensity score weighting. Dementia risk was estimated using cause-specific hazards models with death as a competing risk. RESULTS Of 221,683 patients in the midlife cohort, 1,793 experienced their first severe hypoglycemic event. Over a median of 9.14 years, 3,117 dementia outcomes occurred (32 among exposed). Of 223,940 patients in the late-life cohort, 2,466 experienced their first severe hypoglycemic event. Over a median of 6.7 years, 15,997 dementia outcomes occurred (158 among exposed). The rate of dementia was higher for those with (vs. without) hypoglycemia in both the mid- (hazard ratio 2.85; 95% CI 1.72-4.72) and late-life (2.38; 1.83-3.11) cohorts. CONCLUSIONS Both mid- and late-life hypoglycemia were associated with approximately double the risk of dementia, indicating the need for prevention throughout the life course of those with diabetes.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Iliana C Lega
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Dao L, Choi S, Freeby M. Type 2 diabetes mellitus and cognitive function: understanding the connections. Curr Opin Endocrinol Diabetes Obes 2023; 30:7-13. [PMID: 36385094 DOI: 10.1097/med.0000000000000783] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW To review the connection between type 2 diabetes and cognitive dysfunction, including its epidemiology, potential mechanisms of pathophysiology, risk factors, possible prevention, and treatment considerations. RECENT FINDINGS Diabetes is a risk factor for mild cognitive decline, in addition to Alzheimer's disease and vascular dementia. Duration of diabetes, concomitant vascular or associated co-morbidities, hyper- and hypoglycemia may lead to worsening cognitive dysfunction. Unfortunately, there is a lack of evidence-based guidance on the prevention of cognitive dysfunction in the diabetes population. Studies of diabetes medications, including metformin, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2) have shown some benefit with cardiovascular morbidity and may affect cognition. In the absence of clearly defined preventive tools, diabetes practice guidelines recommend annual cognitive screening as standard of care in adults with diabetes aged 65 years or older. SUMMARY People living with diabetes are at risk for significant decline in cognitive function. Epidemiology and risk factors are well defined. Prevention and treatment strategies are limited and require further study.
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Affiliation(s)
- Lisa Dao
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine UCLA
| | - Sarah Choi
- UCLA School of Nursing, Los Angeles, California, USA
| | - Matthew Freeby
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine UCLA
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Li X, Wu J, Xu F, Chu C, Li X, Shi X, Zheng W, Wang Z, Jia Y, Xiao W. Use of Ferulic Acid in the Management of Diabetes Mellitus and Its Complications. Molecules 2022; 27:molecules27186010. [PMID: 36144745 PMCID: PMC9503003 DOI: 10.3390/molecules27186010] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 12/06/2022] Open
Abstract
Diabetes mellitus, a metabolic disease mainly characterized by hyperglycemia, is becoming a serious social health problem worldwide with growing prevalence. Many natural compounds have been found to be effective in the prevention and treatment of diabetes, with negligible toxic effects. Ferulic acid (FA), a phenolic compound commonly found in medicinal herbs and the daily diet, was proved to have several pharmacological effects such as antihyperglycemic, antihyperlipidemic and antioxidant actions, which are beneficial to the management of diabetes and its complications. Data from PubMed, EM-BASE, Web of Science and CNKI were searched with the keywords ferulic acid and diabetes mellitus. Finally, 28 articles were identified after literature screening, and the research progress of FA for the management of DM and its complications was summarized in the review, in order to provide references for further research and medical applications of FA.
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Affiliation(s)
- Xu Li
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
| | - Jingxian Wu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Fanxing Xu
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Chun Chu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Xiang Li
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Xinyi Shi
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Wen Zheng
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Zhenzhong Wang
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
| | - Ying Jia
- Faculty of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China
- Correspondence: (Y.J.); (W.X.)
| | - Wei Xiao
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- Correspondence: (Y.J.); (W.X.)
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Hypoglycaemia and the risk of dementia: a population-based cohort study using exposure density sampling. Int J Epidemiol 2022:6680498. [PMID: 36048015 DOI: 10.1093/ije/dyac168] [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: 04/05/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have shown hypoglycaemia to be associated with an increased risk of dementia; however, there are several design challenges to consider. The objective of this study is to assess the association between hypoglycaemia and dementia while addressing these challenges using a lag period, exposure density sampling (EDS) and inverse probability of treatment weighting (IPTW). METHODS This was a population-based cohort using data (1996-2018) from British Columbia, Canada. From a cohort of incident type 2 diabetes patients aged 40-70 years, we created a dynamic sub-cohort of hypoglycaemia-exposed (≥1 episode requiring hospitalization or a physician visit) and unexposed individuals using EDS, in which four unexposed individuals per one exposed were randomly selected into risk sets based on diabetes duration and age. Follow-up was until dementia diagnosis, death, emigration or 31 December 2018. Those diagnosed with dementia within 2 years of follow-up were censored. We adjusted for confounding using IPTW and estimated the hazard ratio (HR, 95% CI) of dementia using weighted conditional cause-specific hazards risk models with death as a competing risk. RESULTS Among 13 970 patients with incident type 2 diabetes, 2794 experienced hypoglycaemia. There were 329 dementia events over a median (interquartile range: IQR) follow-up of 5.03 (5.7) years. IPTW resulted in well-balanced groups with weighted incidence rates (95% CI) of 4.59 (3.52, 5.98)/1000 person-years among exposed and 3.33 (2.58, 3.88)/1000 person-years among unexposed participants. The risk of dementia was higher among those with hypoglycaemia (HR, 1.83; 95% CI 1.31, 2.57). CONCLUSIONS After addressing several methodological challenges, we showed that hypoglycaemia contributes to an increased risk of all-cause dementia among patients with type 2 diabetes.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Iliana C Lega
- Women's College Research Institute (WCRI), Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Shang J, Che S, Zhu M. Oleuropein Improves Cognitive Dysfunction and Neuroinflammation in Diabetic Rats through the PI3K/Akt/mTOR Pathway. Appl Bionics Biomech 2022; 2022:5892463. [PMID: 35528541 PMCID: PMC9071920 DOI: 10.1155/2022/5892463] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To explore the effect and mechanism of oleuropein on cognitive dysfunction and neuroinflammation in diabetic rats. Method A diabetic rat model was constructed using streptozotocin, and the diabetic rats were divided into 3 groups with different treatment for 4 weeks, named STZ group (gavaged with normal saline), STZ+LOE group (40 mg/kg oleuropein, and STZ+SITA group (30 mg/kg sitagliptin). The fasting blood glucose (FBG), fasting serum insulin levels, and HOMA-IR index were measured in rats. After the last treatment, the Morris water maze experiment was carried out, and the rats were first subjected to training experiments for 4 consecutive days; the escape latency, number of crossing platform quadrant intersections, time spent in the target quadrant, and swimming speed were recorded. Additionally, the malondialdehyde (MDA), myeloperoxidase (MPO) content, superoxide dismutase (SOD) activity, interleukin- (IL-) 1β, tumor necrosis factor (TNF-α), and phosphatidylinositol 3-kinases (PI3K)/threonine-protein kinase (Akt)/mTOR expression levels in rat hippocampus tissues were detected. Results Oleuropein reduced insulin resistance, spatial learning, and memory ability in diabetic rats. It also could improve oxidative stress and inflammatory response and activate the PI3K/Akt/mTOR signaling pathway in hippocampus tissues. Conclusion Oleuropein ameliorates cognitive dysfunction and neuroinflammation in diabetic rats by regulating the PI3K/Akt/mTOR signaling pathway.
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Affiliation(s)
- Jianru Shang
- Department of Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan Hubei 442000, China
| | - Shan Che
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan Hubei 442000, China
| | - Mingjie Zhu
- Department of Endocrinology, Renmin Hospital, Hubei University of Medicine, Shiyan Hubei 442000, China
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Mehan S, Bhalla S, Siddiqui EM, Sharma N, Shandilya A, Khan A. Potential Roles of Glucagon-Like Peptide-1 and Its Analogues in Dementia Targeting Impaired Insulin Secretion and Neurodegeneration. Degener Neurol Neuromuscul Dis 2022; 12:31-59. [PMID: 35300067 PMCID: PMC8921673 DOI: 10.2147/dnnd.s247153] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/16/2022] [Indexed: 12/20/2022] Open
Abstract
Dementia is a chronic, irreversible condition marked by memory loss, cognitive decline, and mental instability. It is clinically related to various progressive neurological diseases, including Parkinson’s disease, Alzheimer’s disease, and Huntington’s. The primary cause of neurological disorders is insulin desensitization, demyelination, oxidative stress, and neuroinflammation accompanied by various aberrant proteins such as amyloid-β deposits, Lewy bodies accumulation, tau formation leading to neurofibrillary tangles. Impaired insulin signaling is directly associated with amyloid-β and α-synuclein deposition, as well as specific signaling cascades involved in neurodegenerative diseases. Insulin dysfunction may initiate various intracellular signaling cascades, including phosphoinositide 3-kinase (PI3K), c-Jun N-terminal kinases (JNK), and mitogen-activated protein kinase (MAPK). Neuronal death, inflammation, neuronal excitation, mitochondrial malfunction, and protein deposition are all influenced by insulin. Recent research has focused on GLP-1 receptor agonists as a potential therapeutic target. They increase glucose-dependent insulin secretion and are beneficial in neurodegenerative diseases by reducing oxidative stress and cytokine production. They reduce the deposition of abnormal proteins by crossing the blood-brain barrier. The purpose of this article is to discuss the role of insulin dysfunction in the pathogenesis of neurological diseases, specifically dementia. Additionally, we reviewed the therapeutic target (GLP-1) and its receptor activators as a possible treatment of dementia.
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Affiliation(s)
- Sidharth Mehan
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
- Correspondence: Sidharth Mehan, Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, 142001, Punjab, India, Tel +91 8059889909; +91 9461322911, Email ;
| | - Sonalika Bhalla
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Ehraz Mehmood Siddiqui
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Nidhi Sharma
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Ambika Shandilya
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Andleeb Khan
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan, Kingdom of Saudi Arabia
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Prevalence of Moderate to Severe Anxiety Symptoms among Patients with Myocardial Infarction: a Meta-Analysis. Psychiatr Q 2022; 93:161-180. [PMID: 34013389 DOI: 10.1007/s11126-021-09921-y] [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] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
This study attempted to synthesize the evidence on the prevalence of moderate to severe anxiety symptoms among myocardial infarction (MI) patients to offer a reliable and accurate estimate on the number of MI patients suffering from moderate to severe anxiety symptoms. Comprehensive electronic searches (PubMed, Embase and Web of Science) were performed from their inception to February 2021. Between-study heterogeneity was analyzed using the Cochran's Q test and [Formula: see text] statistic, and if it was high across the eligible studies, meta-regression and subgroup analyses were conducted to examine the source of heterogeneity. Publication bias and the robustness of the pooled results were also examined. A total of 18 eligible studies covering 8,532 MI patients were included, of which 3,443 were identified with moderate to severe anxiety symptoms. Between-study heterogeneity was high ([Formula: see text]=98.8%) with the reported prevalence ranging from 9.6% to 69.17%, and the pooled prevalence was 38.08% (95% confidence interval: 28.82-47.81%) by a random-effects model. Meta-regression analyses indicated that publication year (β = -0.014) was significant moderators contributing 16.11% to the heterogeneity. Subgroup analyses indicated that studies using the anxiety subscale of Brief Symptom Inventory to assess anxiety were homogenous ([Formula: see text]=0.0). Furthermore, the pooled prevalence of moderate to severe anxiety symptoms varied significantly by geographic region, instrument used to assess anxiety, methodological quality, sex, education level, a history of previous MI and hypercholesterolemia. Additionally, the results of Egger's linear test (t = -0.630) and Begg's rank test (z = -0.190) indicated no evidence of publication bias, and the sensitivity of the pooled results was low. Nearly two fifth of MI patients suffered from moderate to severe anxiety symptoms, which emphasizes the importance of early identification of anxiety symptoms after MI, as well as the need of implementing psychological interventions for those with elevated anxiety symptoms.
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12
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Huang L, Zhu M, Ji J. Association between hypoglycemia and dementia in patients with diabetes: a systematic review and meta-analysis of 1.4 million patients. Diabetol Metab Syndr 2022; 14:31. [PMID: 35164844 PMCID: PMC8842524 DOI: 10.1186/s13098-022-00799-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is known to be a risk factor for dementia. However, it is unclear if hypoglycemic events play a role in the risk of dementia. We aimed to systematically review evidence on the risk of dementia in DM patients based on prior hypoglycemic events. METHODS PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched till 15th November 2021 for cohort studies assessing the risk of dementia based on prior hypoglycemic events in DM patients. Adjusted data were pooled in a random-effects model. RESULTS Ten studies with a total of 1,407,643 patients were included. Pooled analysis of all ten studies indicated that hypoglycemic episodes were associated with a statistically significant increase in the risk of dementia in DM patients as compared to those not experiencing hypoglycemic episodes (HR: 1.44 95% CI: 1.26, 1.65 I2 = 89% p < 0.00001). The results did not change on the exclusion of any study. Sub-group analysis based on the study population, type of study, adjustment for glycated hemoglobin, gender, and the number of hypoglycemic episodes also presented similar results. CONCLUSIONS Evidence from observational studies with a large sample size indicates that DM patients with hypoglycemic episodes are at increased risk of dementia. Anti-hyperglycemic drugs should be adequately tailored in these patients to avoid the risk of dementia.
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Affiliation(s)
- Lifen Huang
- Department of Geriatrics, Lishui Second People's Hospital, Lishui, China
| | - Manlian Zhu
- Department of Geriatrics, Lishui Second People's Hospital, Lishui, China
| | - Jie Ji
- Department of Geriatrics, Lishui Second People's Hospital, Lishui, China.
- Department of Rehabilitation, Lishui Second People's Hospital, Fifth floor, Rehabilitation Building, 69 Huan North Road, Lishui, China.
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Frank CJ, McNay EC. Breakdown of the blood-brain barrier: A mediator of increased Alzheimer's risk in patients with metabolic disorders? J Neuroendocrinol 2022; 34:e13074. [PMID: 34904299 PMCID: PMC8791015 DOI: 10.1111/jne.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/12/2021] [Accepted: 11/26/2021] [Indexed: 01/03/2023]
Abstract
Metabolic disorders (MDs), including type 1 and 2 diabetes and chronic obesity, are among the faster growing diseases globally and are a primary risk factor for Alzheimer's disease (AD). The term "type-3 diabetes" has been proposed for AD due to the interrelated cellular, metabolic, and immune features shared by diabetes, insulin resistance (IR), and the cognitive impairment and neurodegeneration found in AD. Patients with MDs and/or AD commonly exhibit altered glucose homeostasis and IR; systemic chronic inflammation encompassing all of the periphery, blood-brain barrier (BBB), and central nervous system; pathological vascular remodeling; and increased BBB permeability that allows transfusion of neurotoxic molecules from the blood to the brain. This review summarizes the components of the BBB, mechanisms through which MDs alter BBB permeability via immune and metabolic pathways, the contribution of BBB dysfunction to the manifestation and progression of AD, and current avenues of therapeutic research that address BBB permeability. In addition, issues with the translational applicability of current animal models of AD regarding BBB dysfunction and proposals for future directions of research that address the relationship between MDs, BBB dysfunction, and AD are discussed.
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Affiliation(s)
- Corey J Frank
- Behavioral Neuroscience, University at Albany, SUNY, Albany, NY, USA
| | - Ewan C McNay
- Behavioral Neuroscience, University at Albany, SUNY, Albany, NY, USA
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Lin L, Wu Y, Chen Z, Huang L, Wang L, Liu L. Severe Hypoglycemia Contributing to Cognitive Dysfunction in Diabetic Mice Is Associated With Pericyte and Blood-Brain Barrier Dysfunction. Front Aging Neurosci 2021; 13:775244. [PMID: 34899278 PMCID: PMC8662820 DOI: 10.3389/fnagi.2021.775244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Severe hypoglycemia can cause cognitive impairment in diabetic patients, but the underlying molecular mechanism remains unclear. Objective: To assess the effect of severe hypoglycemia on cognitive function in diabetic mice to clarify the relationship between the mechanism and dysfunction of pericytes and the blood–brain barrier (BBB). Method: We established type 1 diabetes mellitus in 80 male C57BL/6J mice by intraperitoneal injection of streptozotocin (150 mg/kg). Further intraperitoneal injection of short-acting insulin induced severe hypoglycemia. The mice were divided into normal, diabetes, and diabetic + severe hypoglycemia groups, and their blood glucose and general weight index were examined. Pericyte and BBB morphology and function were detected by histological and western blot analyses, BBB permeability was detected by Evans blue staining, and cognitive function was detected with the Morris water maze. Results: Severe hypoglycemia aggravated the histological damage, BBB damage, brain edema, and pericyte loss in the diabetic mice. It also reduced the expression of the BBB tight junction proteins occludin and claudin-5, the expression of the pericyte-specific markers PDGFR-β (platelet-derived growth factor receptor-β) and α-SMA, and increased the expression of the inflammatory factor MMP9. At the same time, diabetic mice with severe hypoglycemia had significantly reduced cognitive function. Conclusion: Severe hypoglycemia leads to cognitive dysfunction in diabetic mice, and its possible mechanism is related to pericyte dysfunction and BBB destruction.
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Affiliation(s)
- Lu Lin
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yubin Wu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhou Chen
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Lishan Huang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lijing Wang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Libin Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
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15
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Heat Shock-Related Protein Responses and Inflammatory Protein Changes Are Associated with Mild Prolonged Hypoglycemia. Cells 2021; 10:cells10113109. [PMID: 34831332 PMCID: PMC8618421 DOI: 10.3390/cells10113109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Mild hypoglycemia is common in clinical practice. Severe hypoglycemia results in heat shock protein and associate co-chaperone changes. Whether mild prolonged hypoglycemia elicits a similar response with inflammatory and oxidative-stress responses compared with a severe hypoglycemic event is unclear; therefore, this pilot exploratory study was undertaken. We performed a case–control induced hypoglycemia clamp study, maintaining blood glucose at 2.8 mmol/L (50 mg/dL) for 1 h in 17 subjects (T2D (n = 10); controls (n = 7)). Blood sampling was performed at baseline, hypoglycemia, and 24 h; slow off-rate modified aptamer (SOMA)-scan plasma protein analysis of HSP-related proteins, inflammatory stress markers, and oxidative stress markers was performed. In total, 16 HSPs were analyzed. At baseline, TLR4:MD-2 complex was elevated (p = 0.01), whilst HSPA8 was lower (p < 0.05) in T2D. At hypoglycemia, UBE2N, STIP1, and UBE2L3 increased (all p < 0.05), whilst TLR4:MD-2 and HSPA8 decreased (p < 0.05) in T2D versus baseline. In follow-up after hypoglycemia, HSPs normalized to baseline by 24 h, except UBE2L3 (p < 0.05), which was decreased in controls versus baseline. Correlation of altered inflammatory markers with HSPs revealed the following: at baseline, TLR4:MD-2 correlated with CXCL10 (p < 0.01) and SIGLEC1 (p < 0.05) in controls; HSPA8 negatively correlated with IL5 (p < 0.05) in T2D. A negative correlation between urinary isoprostane 8-iso PGF2α, a marker of oxidative stress, and HSPA1A was seen at 24 h in T2D only (p < 0.05). In conclusion, the HSP changes seen for mild prolonged hypoglycemia were similar to those previously reported for a severe event. However, mild prolonged hypoglycemia appeared to elicit an increased inflammatory response that was associated with heat shock and related proteins.
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Impact of severe hypoglycemia on the heat shock and related protein response. Sci Rep 2021; 11:17057. [PMID: 34426634 PMCID: PMC8382834 DOI: 10.1038/s41598-021-96642-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Heat shock proteins contribute to diabetes-induced complications and are affected by glycemic control. Our hypothesis was that hypoglycemia-induced heat shock and related protein changes would be amplified in type 2 diabetes (T2D). This prospective, case-control study enrolled 23 T2D patients and 23 control subjects who underwent hyperinsulinemic-induced hypoglycemia (≤ 2.0 mmol/L (36 mg/dl)) with blood sampling at baseline, at hypoglycemia and after a 24-h post-hypoglycemia follow-up period. Proteomic analysis of heat shock-related and pro-inflammatory proteins was performed. At baseline, MAPKAPK5 (p = 0.02) and UBE2G2 (p = 0.003) were elevated and STUB1 decreased (p = 0.007) in T2D. At hypoglycemia: PPP3CA (p < 0.03) was increased and EPHA2 (p = 0.01) reduced in T2D; by contrast, three proteins were reduced in controls [HSPA1A (p = 0.007), HSPB1 (p < 0.02), SMAD3 (p = 0.005)] while only MAPKAPK5 was elevated (p = 0.02). In the post-hypoglycemia follow-up period, most proteins normalized to baseline by 24-h; however, STIP1 (p = 0.003), UBE2N (p = 0.004) and UBE2L3 (p < 0.04) were decreased in controls at 24-h. No protein differed from baseline at 24-h in T2D. Pro-inflammatory interleukin-6 increased at 4-h post-hypoglycemia in controls and T2D (p < 0.05 and p < 0.003, respectively) and correlated with HSPA1A; anti-inflammatory IL-10 decreased 2-h post-hypoglycemia in T2D only. Other pro-inflammatory proteins, IL-1α, IFN-γ and TNF-α, were unchanged. Heat shock and related proteins differed at baseline between T2D and controls, with an exaggerated response of heat shock and related proteins to hypoglycemia that returned to baseline, though with changes at 24-h in controls alone. An increase in pro-inflammatory IL-6, with a decrease in anti-inflammatory IL-10, suggests that the HSP system is overactivated due to underlying inflammation in T2D.Trial registration: ClinicalTrials.gov NCT03102801.
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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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Moin ASM, Kahal H, Al-Qaissi A, Kumar N, Sathyapalan T, Atkin SL, Butler AE. Amyloid-related protein changes associated with dementia differ according to severity of hypoglycemia. BMJ Open Diabetes Res Care 2021; 9:9/1/e002211. [PMID: 33931404 PMCID: PMC8098766 DOI: 10.1136/bmjdrc-2021-002211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hypoglycemia in type 2 diabetes (T2D) may increase risk for Alzheimer's disease (AD), but no data on changes in AD-related proteins with differing degrees of hypoglycemia exist. We hypothesized that milder prolonged hypoglycemia would cause greater AD-related protein changes versus severe transient hypoglycemia. RESEARCH DESIGN AND METHODS Two prospective case-control induced hypoglycemia studies were compared: study 1, hypoglycemic clamp to 2.8 mmol/L (50 mg/dL) for 1 hour in 17 subjects (T2D (n=10), controls (n=7)); study 2, hypoglycemic clamp to 2.0 mmol/L (36 mg/dL) undertaken transiently and reversed in 46 subjects (T2D (n=23), controls (n=23)). Blood sampling at baseline, hypoglycemia and 24-hour post-hypoglycemia, with proteomic analysis of amyloid-related proteins performed. RESULTS In control subjects, the percentage change from baseline to hypoglycemia differed between study 1 and study 2 for 5 of 11 proteins in the AD-related panel: serum amyloid A1 (SAA1) (p=0.009), pappalysin (PAPPA) (p=0.002), apolipoprotein E2 (p=0.02), apolipoprotein E3 (p=0.03) and apolipoprotein E4 (p=0.02). In controls, the percentage change from baseline to 24 hours differed between studies for two proteins: SAA1 (p=0.003) and PAPPA (p=0.004); however, after Bonferroni correction only SAA1 and PAPPA remain significant. In T2D, there were no differential protein changes between the studies. CONCLUSIONS The differential changes in AD-related proteins were seen only in control subjects in response to iatrogenic induction of hypoglycemic insults of differing length and severity and may reflect a protective response that was absent in subjects with T2D. Milder prolonged hypoglycemia caused greater AD-related protein changes than severe acute hypoglycemia in control subjects. TRIAL REGISTRATION NUMBERS NCT02205996, NCT03102801.
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Affiliation(s)
- Abu Saleh Md Moin
- Diabetes Research Center, Qatar Biomedical Research Institute, Doha, Qatar
| | - Hassan Kahal
- Diabetes and Metabolism, Hull York Medical School, Hull, UK
| | - Ahmed Al-Qaissi
- Diabetes and Metabolism, Hull York Medical School, Hull, UK
- Diabetes and Metabolism, Leeds Medical School, Leeds, UK
| | - Nitya Kumar
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | | | - Stephen L Atkin
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Alexandra E Butler
- Diabetes Research Center, Qatar Biomedical Research Institute, Doha, Qatar
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Li CY, Kuo CL, Chang YH, Lu CL, Martini S, Hou WH. Association between trajectory of severe hypoglycemia and dementia in patients with type 2 diabetes: A population-based study. J Epidemiol 2021; 32:423-430. [PMID: 33678721 PMCID: PMC9359896 DOI: 10.2188/jea.je20200518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background We aimed to investigate associations between exposure to various trajectories of severe hypoglycemic events and risk of dementia in patients with type 2 diabetes. Methods In 2002–2003, 677,618 patients in Taiwan were newly diagnosed as having type 2 diabetes. Among them, 35,720 (5.3%) experienced severe hypoglycemic events during the 3-year baseline period following diagnosis. All patients were followed from the first day after baseline period to the date of dementia diagnosis, death, or the end of 2011. A group-based trajectory model was used to classify individuals with severe hypoglycemic events during the baseline period. Cox proportional hazard models with the competing risk method were used to relate dementia risk to various severe hypoglycemia trajectories. Results After a median follow-up 6.70 and 6.10 years for patients with and without severe hypoglycemia at baseline, respectively, 1,952 (5.5%) individuals with severe hypoglycemia and 23,492 (3.7%) without developed dementia during follow-up, for incidence rates of 109.80 and 61.88 per 10,000 person-years, respectively. Four groups of severe hypoglycemia trajectory were identified with a proportion of 18.06%, 33.19%, 43.25%, and 5.50%, respectively, for Groups 1 to 4. Groups 3 (early manifestation but with later decrease) and 4 (early and sustained manifestation) were associated with a significantly increased risk of dementia diagnosis, with a covariate-adjusted subdistribution hazard ratio of 1.22 (95% confidence interval, 1.14–1.31) and 1.25 (95% confidence interval, 1.02–1.54), respectively. Conclusion Our analysis highlighted that early manifestation of severe hypoglycemic events may contribute more than does late manifestation to the risk of dementia among individuals newly diagnosed as having type 2 diabetes.
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Affiliation(s)
- Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University.,Department of Epidemiology, Faculty of Public Health, Universitas Airlangga.,Department of Public Health, College of Public Health, China Medical University.,Department of Healthcare Administration, College of Medical and Health Science, Asia University
| | - Chia-Lun Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University.,Department of Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga
| | - Wen-Hsuan Hou
- School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University.,Center of Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital
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Moin ASM, Al-Qaissi A, Sathyapalan T, Atkin SL, Butler AE. Hypoglycaemia in type 2 diabetes exacerbates amyloid-related proteins associated with dementia. Diabetes Obes Metab 2021; 23:338-349. [PMID: 33026133 DOI: 10.1111/dom.14220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
AIMS Hypoglycaemia in diabetes (T2D) may increase the risk of Alzheimer's disease (AD). We hypothesized that hypoglycaemia-induced amyloid-related protein changes would be exacerbated in T2D. MATERIALS AND METHODS A prospective, parallel study in T2D (n = 23) and controls (n = 23). Subjects underwent insulin-induced hypoglycaemia with blood sampling at baseline, hypoglycaemia and post-hypoglycaemia; proteomic analysis of amyloid-related proteins was undertaken. RESULTS At baseline, amyloid-precursor protein (APP) (P < .01) was elevated and alpha-synuclein (SNCA) (P < .01) reduced in T2D. At hypoglycaemia, amyloid P-component (P < .01) was elevated and SNCA (P < .05) reduced in T2D; APP (P < .01) and noggin (P < .05) were elevated and SNCA (P < .01) reduced in controls. In the post-hypoglycaemia follow-up period, APP and microtubule-associated protein tau normalized in controls but showed a below-baseline decrease in T2D; noggin normalized in both; SNCA normalized in T2D, with a below-baseline decrease in controls. CONCLUSION The AD-associated protein pattern found in T2D, with basal elevated APP and reduced SNCA, was exaggerated by hypoglycaemia with increased APP and decreased SNCA. Additional AD-associated protein levels that changed in response to hypoglycaemia, particularly in T2D, included amyloid P-component, microtubule-associated protein tau, apolipoproteins A1 and E3, pappalysin and noggin. These results are in accordance with the reported detrimental effects of hypoglycaemia.
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Affiliation(s)
- Abu Saleh Md Moin
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Ahmed Al-Qaissi
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
- Leeds Medical School, Leeds, UK
| | | | | | - Alexandra E Butler
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
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Mattishent K, Loke YK. Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents. Front Endocrinol (Lausanne) 2021; 12:571568. [PMID: 33763024 PMCID: PMC7982741 DOI: 10.3389/fendo.2021.571568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We conducted a meta-analysis of serious adverse events (dementia, macro- and micro-vascular events, falls and fractures, and death) associated with hypoglycemia in older patients treated with glucose lowering drugs. MATERIALS AND METHODS Meta-analysis of studies reporting on hypoglycemia and adverse events. The search included studies from two previously published systematic reviews, and an updated search of MEDLINE and EMBASE from April 2014 to November 2019. We assessed study validity based on ascertainment of hypoglycemia, adverse events and adjustment for confounders, and conducted a random effects meta-analyses, assessing heterogeneity using the I2 statistic. RESULTS We included 44 studies involving 2,507,434 participants. Most of the studies used adjusted analysis for confounders and hypoglycaemic events were typically identified based on healthcare databases (severe events). Hypoglycemia was associated with increased likelihood of death in a meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval 1.75-2.32). Studies assessing mortality signal a time-response relationship with a higher risk of adverse events occurring within the first 90 days after hypoglycemia. Our meta-analysis of nine studies demonstrated that hypoglycaemic episodes were associated with dementia - pooled OR 1.50 (95% CI 1.29-1.74). Our meta-analysis of nineteen studies demonstrated associations between hypoglycaemia and macrovascular complications, pooled OR 1.81 (95% CI 1.70-1.94), and microvascular complications (two studies) pooled OR 1.77 (95% CI 1.49-2.10). There is also an association between hypoglycemia and cardiovascular death (six studies) - pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our meta-analysis of six studies demonstrated an association between hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44-2.21) and 1.68 (95% CI 1.37-2.07) respectively. CONCLUSION This meta-analysis confirms previously reported concerns of serious harm following hypoglycemia, especially in the immediate time period after a hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a priority in this vulnerable population.
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Sinclair A, Abdelhafiz A. Cognitive Dysfunction in Older Adults with Type 2 Diabetes: Links, Risks, and Clinical Implications. Clin Geriatr Med 2020; 36:407-417. [PMID: 32586471 DOI: 10.1016/j.cger.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of comorbid diabetes and cognitive dysfunction increases as the population ages. Diabetes increases the risk of progression of cognitive dysfunction through a spectrum of cognitive decline to mild cognitive impairment then to dementia. Cognitive dysfunction, especially impairment in the executive domain, has a negative impact on patients' self-care tasks. With further progression of dementia and the development of behavioral problems, the challenge to carers and health care professionals looking after these patients is significant. Therefore, clinical trials are needed to explore the impact of novel hypoglycemic therapy on cognitive function as an important outcome in this population.
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Affiliation(s)
- Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.
| | - Ahmed Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
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Abstract
Hypoglycemia is a serious problem in older patients with diabetes mellitus. This chapter discusses risk factors associated with hypoglycemia and approaches to mitigation of the risk for hypoglycemia. Specific considerations include selection of glucose lowering agents, comorbid conditions and the implications of declining cognitive dysfunction.
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Affiliation(s)
- Byron J Hoogwerf
- Cleveland Clinic, Cleveland, OH, USA; Central Michigan University, College of Medicine, Mount Pleasant, MI, USA.
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24
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Medrano-De-Ávila C, Castillo-Castro C, Lavalle-González FJ. Comment on Lacy et al. Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes. Diabetes Care 2018;41:2339-2345. Diabetes Care 2019; 42:e68. [PMID: 30894390 DOI: 10.2337/dc18-2467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Carolina Medrano-De-Ávila
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Carolina Castillo-Castro
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Abdelhafiz AH, Sinclair AJ. Cognitive Frailty in Older People with Type 2 Diabetes Mellitus: the Central Role of Hypoglycaemia and the Need for Prevention. Curr Diab Rep 2019; 19:15. [PMID: 30806826 DOI: 10.1007/s11892-019-1135-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia. RECENT FINDINGS Cognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitive frailty. The incidence of hypoglycaemia in older people with diabetes is rising and hypoglycaemia-related hospitalisation has overtaken that of hyperglycaemia. Recognition of hypoglycaemic episodes in old age remains challenging which leads to misdiagnoses and under-reporting. Therefore, hypoglycaemia prevention strategies are needed. Research is still required to investigate whether prevention of hypoglycaemia would lead to a reduction in the incidence of cognitive frailty.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK
- Kings College, London, SE1 9NH, UK
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McMillan JM, Mele BS, Hogan DB, Leung AA. Impact of pharmacological treatment of diabetes mellitus on dementia risk: systematic review and meta-analysis. BMJ Open Diabetes Res Care 2018; 6:e000563. [PMID: 30487973 PMCID: PMC6254737 DOI: 10.1136/bmjdrc-2018-000563] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The association between diabetes mellitus (DM) treatment and dementia is not well understood. OBJECTIVE To investigate the association between treatment of diabetes, hypoglycemia, and dementia risk. RESEARCH DESIGN AND METHODS We performed a systematic review and meta-analysis of pharmacological treatment of diabetes and incident or progressive cognitive impairment. We searched Ovid MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, and PsychINFO from inception to 18 October 2017. We included cross-sectional, case-control, cohort, and randomized controlled studies. The study was registered with PROSPERO (ID CRD42017077953). RESULTS We included 37 studies into our systematic review and 13 into our meta-analysis. Ten studies investigated any antidiabetic treatment compared with no treatment or as add-on therapy to prior care. Treatment with an antidiabetic agent, in general, was not associated with incident dementia (risk ratio (RR) 1.01; 95% CI 0.93 to 1.10). However, we found differential effects across drug classes, with a signal of harm associated with insulin therapy (RR 1.21; 95% CI 1.06 to 1.39), but potentially protective effects with thiazolidinedione exposure (RR 0.71; 95% CI 0.55 to 0.93). Severe hypoglycemic episodes were associated with a nearly twofold increased likelihood of incident dementia (RR 1.77; 95% CI 1.35 to 2.33). Most studies did not account for DM duration or severity. CONCLUSIONS AND LIMITATIONS The association between treatment for diabetes and dementia is differential according to drug class, which is potentially mediated by hypoglycemic risk. Not accounting for DM duration and/or severity is a major limitation in the available evidence base.
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Affiliation(s)
- Jacqueline M McMillan
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Bria S Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - David B Hogan
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Alexander A Leung
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Kim SH, Lee SY, Kim CW, Suh YJ, Hong S, Ahn SH, Seo DH, Nam MS, Chon S, Woo JT, Baik SH, Park Y, Lee KW, Kim YS. Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus. Diabetes Metab J 2018; 42:380-393. [PMID: 30113143 PMCID: PMC6202566 DOI: 10.4093/dmj.2017.0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/14/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition. METHODS A total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income. RESULTS Lower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; P(trend)=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; P(trend)=0.048). In women, lower income was associated with a higher stress level. CONCLUSION Men with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.
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Affiliation(s)
- So Hun Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seung Youn Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Chei Won Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Seongbin Hong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seong Hee Ahn
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Da Hae Seo
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon Suk Nam
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yongsoo Park
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Young Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
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Nauck M, Araki A, Hehnke U, Plat A, Clark D, Khunti K. Risk of hypoglycaemia in people aged ≥65 years receiving linagliptin: pooled data from 1489 individuals with type 2 diabetes mellitus. Int J Clin Pract 2018; 72:e13240. [PMID: 30216648 DOI: 10.1111/ijcp.13240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS To investigate the risk of hypoglycaemia in people aged ≥65 years with type 2 diabetes mellitus (T2DM) treated with linagliptin, in the largest pooled analysis performed to date. MATERIALS AND METHODS One thousand four hundred and eighty-nine patients aged ≥65 years with T2DM were pooled from 11 randomised, double-blind, parallel group, placebo-controlled trials evaluating linagliptin 5 mg alone, or in addition to various background therapies. The primary safety endpoint was the incidence of investigator-defined hypoglycaemia. RESULTS There was no significant difference in the risk of hypoglycaemia between linagliptin and placebo in the all-patient population at 24 weeks (hazard ratio [HR] 1.07; 95% confidence interval [CI]: 0.84, 1.36; P = 0.5943)-despite significant (P < 0.0001) improvements in glycaemic control-and 1 year (HR 1.02; 95% CI: 0.81, 1.27; P = 0.8803). Similar findings were observed for linagliptin vs placebo in subgroup analyses by background medication (eg, sulphonylureas (SUs) and/or insulin vs no such drugs), age, baseline glycated haemoglobin (HbA1c), ethnicity, and baseline estimated glomerular filtration rate. Patients with a baseline HbA1c ≥7.5% had significantly higher odds of achieving HbA1c <7.5% without hypoglycaemia in the linagliptin group compared with placebo at 24 weeks (34.1% vs 13.7%; 95% CI: 2.04, 4.12; P < 0.0001). CONCLUSIONS This pooled analysis indicates that linagliptin was effective in treating older people with T2DM towards their HbA1c targets with a favourable safety and tolerability profile and low risk of hypoglycaemia. The safety profile was maintained even on background therapies with known risk of hypoglycaemia, such as insulin and SU.
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Affiliation(s)
- Michael Nauck
- Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Uwe Hehnke
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Arian Plat
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
- Eli Lilly and Company, Utrecht, Netherlands
| | - Douglas Clark
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Cognition, serum BDNF levels, and BDNF Val66Met polymorphism in type 2 diabetes patients and healthy controls. Oncotarget 2017; 9:3653-3662. [PMID: 29423073 PMCID: PMC5790490 DOI: 10.18632/oncotarget.23342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/23/2017] [Indexed: 01/28/2023] Open
Abstract
Background and aims Type 2 diabetes (T2DM) is associated with cognitive deficits. However, their pathophysiological mechanisms are still unknown. Recent study suggests that brain-derived neurotrophic factor (BDNF) is correlated with cognitive deficits in T2DM patients. This study was to determine whether altered serum BDNF levels and cognitive deficits depended on the BDNF Val66Met polymorphism in T2DM. Results The BDNF Val66Met polymorphism may not contribute directly to the susceptibility to T2DM. The total and nearly all index scores (all p < 0.01) except for the attention and visuospatial/constructional indexes (both p > 0.05) of RBANS were markedly decreased in T2DM compared with healthy controls. Serum BDNF levels were significantly lower in patients than that in controls (p < 0.001), and BDNF was positively associated with delayed memory in patients (p < 0.05). The Met variant was associated with worse delayed memory performance among T2DM patients but not among normal controls. Moreover, serum BDNF was positively associated with delayed memory among Met homozygote patients (β = 0.29, t = 2.21, p = 0.033), while serum BDNF was negatively associated the RBANS total score (β = –0.92, t = –3.40, p = 0.002) and language index (β = −1.17, t = –3.54, p = 0.001) among Val homozygote T2DM patients. Conclusions BDNF gene Val66Met variation may be associated with cognitive deficits in T2DM, especially with delayed memory. The association between lower BDNF serum levels and cognitive impairment in T2DM is dependent on the BDNF Val66Met polymorphism. Methods We recruited 311 T2DM patients and 346 healthy controls and compared them on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), serum BDNF levels, and the BDNF Val66Met polymorphism.
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30
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Zhao X, Han Q, Lv Y, Sun L, Gang X, Wang G. Biomarkers for cognitive decline in patients with diabetes mellitus: evidence from clinical studies. Oncotarget 2017; 9:7710-7726. [PMID: 29484146 PMCID: PMC5800938 DOI: 10.18632/oncotarget.23284] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/30/2017] [Indexed: 12/26/2022] Open
Abstract
Diabetes mellitus is considered as an important factor for cognitive decline and dementia in recent years. However, cognitive impairment in diabetic patients is often underestimated and kept undiagnosed, leading to thousands of diabetic patients suffering from worsening memory. Available reviews in this field were limited and not comprehensive enough. Thus, the present review aimed to summarize all available clinical studies on diabetic patients with cognitive decline, and to find valuable biomarkers that might be applied as diagnostic and therapeutic targets of cognitive impairment in diabetes. The biomarkers or risk factors of cognitive decline in diabetic patients could be classified into the following three aspects: serum molecules or relevant complications, functional or metabolic changes by neuroimaging tools, and genetic variants. Specifically, factors related to poor glucose metabolism, insulin resistance, inflammation, comorbid depression, micro-/macrovascular complications, adipokines, neurotrophic molecules and Tau protein presented significant changes in diabetic patients with cognitive decline. Besides, neuroimaging platform could provide more clues on the structural, functional and metabolic changes during the cognitive decline progression of diabetic patients. Genetic factors related to cognitive decline showed inconsistency based on the limited studies. Future studies might apply above biomarkers as diagnostic and treatment targets in a large population, and regulation of these parameters might shed light on a more valuable, sensitive and specific strategy for the diagnosis and treatment of cognitive decline in diabetic patients.
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Affiliation(s)
- Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Qing Han
- Hospital of Orthopedics, The Second Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - You Lv
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Lin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
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31
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Rhee SY, Kim HJ, Ko SH, Hur KY, Kim NH, Moon MK, Park SO, Lee BW, Choi KM, Kim JH. Monotherapy in patients with type 2 diabetes mellitus. Korean J Intern Med 2017; 32:959-966. [PMID: 29057643 PMCID: PMC5668404 DOI: 10.3904/kjim.2017.312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 01/14/2023] Open
Abstract
In order to improve the quality of life and to prevent chronic complications related to diabetes mellitus, intensive lifestyle modification and proper medication are needed from the early stage of diagnosis of type 2 diabetes mellitus (T2DM). When using the first medication for diabetic patients, the appropriate treatment should be selected considering the clinical characteristics of the patient, efficacy of the drug, side effects, and cost. In general, the use of metformin as the first treatment for oral hypoglycemic monotherapy is recommended because of its excellent blood glucose-lowering effect, relatively low side effects, long-term proven safety, low risk of hypoglycemia, and low weight gain. If metformin is difficult to use as a first-line treatment, other appropriate medications should be selected in view of the clinical situation. If the goal of achieving glycemic control is not achieved by monotherapy, a combination therapy with different mechanisms of action should be initiated promptly.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nan-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok-O Park
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei 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
| | - Jin Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Committee of Clinical Practice Guideline of Korean Diabetes Association
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
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Gao F, Chen J, Liu X, Wang X, Zhao H, Han D, Jing X, Liu Y, Cui Z, Li C, Ma J. Latent class analysis suggests four classes of persons with type 2 diabetes mellitus based on complications and comorbidities in Tianjin, China: a cross-sectional analysis. Endocr J 2017; 64:1007-1016. [PMID: 28781339 DOI: 10.1507/endocrj.ej17-0199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to explore a new classification way in persons with type 2 diabetes mellitus based on complications and comorbidities using Latent Class Analysis, moreover, finding out the factors associated with different latent classes and making specific suggestions. In this study, 5,500 patients with type 2 diabetes mellitus from ten hospitals in Tianjin, China were selected, and the response rate was 96.2%. Latent Class Analysis was used to cluster patients. After compared the baseline characteristics, multinomial logistic regression was applied. Patients with type 2 diabetes mellitus were classified into four classes. In the univariate analysis, all variables were significant (p<0.05). According to multinomial logistic regression, we found longer duration of type 2 diabetes mellitus, family history of diabetes, older age, obesity and central obesity, female menopause, living in a suburb, having a higher 2hPG at diagnosis, smoking and drinking were associated with the prevalence of complications and comorbidities. In conclusion, LCA was shown to be an effective method for grouping patients with T2DM, which presented a nuanced approach to data reduction. Further research using LCA may be especially useful to investigate causal relationships between complications and the significant factors identified in our study.
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Affiliation(s)
- Fei Gao
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Jiageng Chen
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Xiaoqian Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Xuying Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Haozuo Zhao
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Duolan Han
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Xiyue Jing
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Yuanyuan Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Zhuang Cui
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Changping Li
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
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Wang H, Sun X, Zhang N, Ji Z, Ma Z, Fu Q, Qu R, Ma S. Ferulic acid attenuates diabetes-induced cognitive impairment in rats via regulation of PTP1B and insulin signaling pathway. Physiol Behav 2017; 182:93-100. [PMID: 28988132 DOI: 10.1016/j.physbeh.2017.10.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/03/2023]
Abstract
Cognitive impairment has been recognized as a typical characteristic of neurodegenerative disease in diabetes mellitus (DM) and this cognitive dysfunction may be a risk factor for Alzheimer's disease (AD). Ferulic acid, a phenolic compound commonly found in a range of plants, has emerged various properties including anti-inflammatory and neuroprotective effects. In the present study, the protective activities and relevant mechanisms of ferulic acid were evaluated in diabetic rats with cognitive deficits, which were induced by a high-glucose-fat (HGF) diet and low dose of streptozotocin (STZ). It was observed that ferulic acid significantly increased body weight and decreased blood glucose levels. Meanwhile, ferulic acid could markedly ameliorate spatial memory of diabetic rats in Morris water maze (MWM) and decrease AD-like pathologic changes (Aβ deposition and Tau phosphorylation) in the hippocampus, which might be correlated with the inhibition of inflammatory cytokines release and reduction of protein tyrosine phosphatase 1B (PTP1B) expression. Moreover, the levels of brain insulin signal molecules p-IRS, p-Akt and p-GSK3β were also investigated. We found that ferulic acid administration restored the alterations in insulin signaling. In conclusion, ferulic acid exhibited beneficial effects on diabetes-induced cognition lesions, which was involved in the regulation of PTP1B and insulin signaling pathway. We suppose that PTP1B inhibition may represent a promising approach to correct abnormal signaling linked to diabetes-induced cognitive impairment.
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Affiliation(s)
- Hao Wang
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Xiaoxu Sun
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Ning Zhang
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Zhouye Ji
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Zhanqiang Ma
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Qiang Fu
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China
| | - Rong Qu
- Department of Pharmacology of Traditional Chinese Medical Formulae, Nanjing University of Traditional Chinese Medicine, 138, Xianlin Road, Nanjing 210029, China
| | - Shiping Ma
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceeutical University, 639, Longmian Road, Nanjing 211198, China.
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Rhee SY, Kim HJ, Ko SH, Hur KY, Kim NH, Moon MK, Park SO, Lee BW, Choi KM, Kim JH. Monotherapy in Patients with Type 2 Diabetes Mellitus. Diabetes Metab J 2017; 41:349-356. [PMID: 29086532 PMCID: PMC5663673 DOI: 10.4093/dmj.2017.41.5.349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 01/05/2023] Open
Abstract
In order to improve the quality of life and to prevent chronic complications related to diabetes mellitus, intensive lifestyle modification and proper medication are needed from the early stage of diagnosis of type 2 diabetes mellitus (T2DM). When using the first medication for diabetic patients, the appropriate treatment should be selected considering the clinical characteristics of the patient, efficacy of the drug, side effects, and cost. In general, the use of metformin as the first treatment for oral hypoglycemic monotherapy is recommended because of its excellent blood glucose-lowering effect, relatively low side effects, long-term proven safety, low risk of hypoglycemia, and low weight gain. If metformin is difficult to use as a first-line treatment, other appropriate medications should be selected in view of the clinical situation. If the goal of achieving glycemic control is not achieved by monotherapy, a combination therapy with different mechanisms of action should be initiated promptly.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seok O Park
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei 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
| | - Jin Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
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Quartuccio M, Buta B, Kalyani RR. Comparative Effectiveness for Glycemic Control in Older Adults with Diabetes. CURRENT GERIATRICS REPORTS 2017; 6:175-186. [PMID: 28920012 PMCID: PMC5585298 DOI: 10.1007/s13670-017-0215-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To review and summarize the current data for comparative effectiveness of glycemic control in older adults. RECENT FINDINGS In the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show cardiovascular benefit from intensive glycemic control and show only minimal microvascular benefit. Additionally, a few studies suggest that suboptimal glycemic control can increase the risk for geriatric syndromes. Emerging research suggests similar safety and efficacy of glucose-lowering therapies in older versus younger adults. SUMMARY Overall, there is a paucity of data supporting the benefit of intensive glycemic control in older adults. More research is needed in this vulnerable population.
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Affiliation(s)
- Michael Quartuccio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
| | - Brian Buta
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
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Zeaxanthin improves diabetes-induced cognitive deficit in rats through activiting PI3K/AKT signaling pathway. Brain Res Bull 2017; 132:190-198. [PMID: 28599877 DOI: 10.1016/j.brainresbull.2017.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 12/16/2022]
Abstract
Published studies have shown that cognitive deficit is a characteristic manifestation of neurodegenerative disease in diabetes. However, there is no effective prevention and treatment for this diabetes-associated behavior disorder. In the present study, we attempted to elucidate the effect of zeaxanthin on cognitive deficit and the change in the hippocampus correlated with cognitive decline in diabetic rats. Diabetic rats in this study were induced by high-fat diet and low-dose streptozocin (STZ), cognitive ability of rats were evaluated use morris water maze (MWM) and morphology change in hippocampus was assessed by cresyl violet stain. Moreover, we detected the expression of phosphorylated serine/threonine kinase (p-AKT) and Cleaved caspase-3, and the activity of nuclear factor-κB (NF-κB) use western-blot (WB). Results displayed that supplementation with zeaxanthin reduce blood glucose, improve cognitive deficit, survive neural cell, increase p-AKT level, inhibit Cleaved caspase-3 level and NF-κB nuclear transcription in hippocampus. This study demonstrated that zeaxanthin ameliorate diabetes-related cognitive deficit may by means of protecting neural cell from hyperglycemia involved in AKT/NF-κB signaling pathway. This study may provide a potential therapeutic approach for the prevention of diabetes- associated cognitive deficit.
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Abstract
Recently, cardiovascular morbidity and mortality have been continuously reduced in people with diabetes through the intensive management of multiple risk factors. However, contrary to this trend, the prevalence and clinical significance of neurodegenerative disorders are steadily increasing. In previous studies, diabetes mellitus has been found to play an important role in increasing the risk of dementia and cognitive dysfunction through various mechanisms. In particular, hypoglycemia is a frequent clinical situation in the strict management of diabetes and is well known as an important factor that directly affects the risk of dementia and cognitive impairment. This article describes the occurrence of hypoglycemia in patients with diabetes, and summarizes the resultant risks of dementia and cognitive dysfunction.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
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Baptista LC, Machado-Rodrigues AM, Martins RA. Exercise but not metformin improves health-related quality of life and mood states in older adults with type 2 diabetes. Eur J Sport Sci 2017; 17:794-804. [PMID: 28394739 DOI: 10.1080/17461391.2017.1310933] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this cohort study is to analyse the effect of three types of treatment: (i) exercise training with multicomponent exercise (E); (ii) pharmacologic treatment with oral hypoglycaemic drug - metformin (M); and (iii) a combined therapy - exercise and metformin (E + M) on health-related quality of life (HRQoL) and mood states in older adults with type 2 diabetes (T2D) with comorbidity in an early stage of the disease. Participants (n = 284) underwent 1 of the following 3 conditions: (i) E (n = 59) trained three times/week; (ii) M (n = 30) used 850 mg of metformin twice daily; and (iii) E + M (n = 195) combined exercise and metformin. Furthermore, participants completed baseline and 2-year follow-up evaluations including a Shortform Health Survey 36, Profile of Mood States - Short-form, the health history questionnaires, anthropometric, and blood biochemistry. E and E + M revealed improved mood states, with large effect size on the vigour domain, and moderate effect size in the anger and total mood disturbance (TMD) domains (P < 0.05), in comparison with the M group. After 24 months' intervention, the E and E + M groups perceived better physical and mental HRQoL than the M group. The M group unchanged HRQoL domains (P > 0.05). Metformin had no significant effect on the self-referred HRQoL in T2D participants aged above 60 years, in an early stage of the disease. The E and E + M were the most effective long-term therapies to improve mood states and HRQoL in older adults with T2D.
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Affiliation(s)
- Liliana C Baptista
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
| | | | - Raul A Martins
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
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