1
|
da Silva AD, Oliveira JS, de Castro IC, Paiva WC, Gomes JMG, Pimenta LCJP. Association of vitamin D and cognition in people with type 2 diabetes: a systematic review. Nutr Rev 2024; 82:622-638. [PMID: 37403328 DOI: 10.1093/nutrit/nuad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
CONTEXT There is a high prevalence of vitamin D deficiency and impaired cognitive function in people with type 2 diabetes mellitus (T2DM). OBJECTIVE To critically and systematically review the literature on the association between vitamin D status and cognitive performance in people with type 2 diabetes. DATA SOURCES This review was conducted according to PRISMA recommendations. MEDLINE, SCOPUS, the Cochrane Library, and Web of Science databases were searched using the terms "Diabetes Mellitus, Type 2", "Cognitive Function", and "Vitamin D". DATA EXTRACTION Eight observational and 1 randomized study were included, containing data of 14 648 adult and elderly individuals (19-74 y). All extracted data were compiled, compared, and critically analyzed. DATA ANALYSIS There is no strong evidence that lower serum concentrations of vitamin D and vitamin D-binding protein are associated with worsening cognitive function in individuals with T2DM. Vitamin D supplementation (12 wk) improved the scores of some executive functioning tests, although there was no difference between low doses (5000 IU/wk) and high doses (50 000 IU/wk). CONCLUSIONS There is no high-quality evidence demonstrating an association between vitamin D status and cognitive function, or clinical benefits on cognition from vitamin D supplementation in individuals with T2DM. Future studies are needed. Systematic Review Registration: PROSPERO registration no. CRD42021261520.
Collapse
Affiliation(s)
- Alice D da Silva
- Department of Nutrition, Universidade Federal de Lavras, Minas Gerais, Brazil
| | - Julia S Oliveira
- Department of Nutrition and Health, Universidade Federal de Viçosa, Minas Gerais, Brazil
| | - Isabela C de Castro
- Department of Nutrition, Universidade Federal de Lavras, Minas Gerais, Brazil
| | - Wanderléia C Paiva
- Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas Gerais, Minas Gerais, Brazil
| | - Júnia M G Gomes
- Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas Gerais, Minas Gerais, Brazil
| | - Laura C J P Pimenta
- Department of Nutrition, Universidade Federal de Lavras, Minas Gerais, Brazil
| |
Collapse
|
2
|
Maimaitituerxun R, Chen W, Xiang J, Xie Y, Xiao F, Wu XY, Chen L, Yang J, Liu A, Dai W. Predictive model for identifying mild cognitive impairment in patients with type 2 diabetes mellitus: A CHAID decision tree analysis. Brain Behav 2024; 14:e3456. [PMID: 38450963 PMCID: PMC10918605 DOI: 10.1002/brb3.3456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND As the population ages, mild cognitive impairment (MCI) and type 2 diabetes mellitus (T2DM) become common conditions that often coexist. Evidence has shown that MCI could lead to reduced treatment compliance, medication management, and self-care ability in T2DM patients. Therefore, early identification of those with increased risk of MCI is crucial from a preventive perspective. Given the growing utilization of decision trees in prediction of health-related outcomes, this study aimed to identify MCI in T2DM patients using the decision tree approach. METHODS This hospital-based case-control study was performed in the Endocrinology Department of Xiangya Hospital affiliated to Central South University between March 2021 and December 2022. MCI was defined based on the Petersen criteria. Demographic characteristics, lifestyle factors, and T2DM-related information were collected. The study sample was randomly divided into the training and validation sets in a 7:3 ratio. Univariate and multivariate analyses were performed, and a decision tree model was established using the chi-square automatic interaction detection (CHAID) algorithm to identify key predictor variables associated with MCI. The area under the curve (AUC) value was used to evaluate the performance of the established decision tree model, and the performance of multivariate regression model was also evaluated for comparison. RESULTS A total of 1001 participants (705 in the training set and 296 in the validation set) were included in this study. The mean age of participants in the training and validation sets was 60.2 ± 10.3 and 60.4 ± 9.5 years, respectively. There were no significant differences in the characteristics between the training and validation sets (p > .05). The CHAID decision tree analysis identified six key predictor variables associated with MCI, including age, educational level, household income, regular physical activity, diabetic nephropathy, and diabetic retinopathy. The established decision tree model had 15 nodes composed of 4 layers, and age is the most significant predictor variable. It performed well (AUC = .75 [95% confidence interval (CI): .71-.78] and .67 [95% CI: .61-.74] in the training and validation sets, respectively), was internally validated, and had comparable predictive value compared to the multivariate logistic regression model (AUC = .76 [95% CI: .72-.80] and .69 [95% CI: .62-.75] in the training and validation sets, respectively). CONCLUSION The established decision tree model based on age, educational level, household income, regular physical activity, diabetic nephropathy, and diabetic retinopathy performed well with comparable predictive value compared to the multivariate logistic regression model and was internally validated. Due to its superior classification accuracy and simple presentation as well as interpretation of collected data, the decision tree model is more recommended for the prediction of MCI in T2DM patients in clinical practice.
Collapse
Affiliation(s)
- Rehanguli Maimaitituerxun
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Wenhang Chen
- Department of NephrologyXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Jingsha Xiang
- Department of Human ResourcesJinan Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Yu Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Fang Xiao
- Department of Toxicology, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Letao Chen
- Infection Control CenterXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Jianzhou Yang
- Department of Preventive MedicineChangzhi Medical CollegeChangzhiShanxiChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| |
Collapse
|
3
|
Wu L, Meng XJ, Xu TB, Zhang XC, Zhou Y, Tong ZF, Jiang JH. Berberine attenuates cognitive dysfunction and hippocampal apoptosis in rats with prediabetes. Chem Biol Drug Des 2024; 103:e14420. [PMID: 38230770 DOI: 10.1111/cbdd.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024]
Abstract
The cognitive dysfunction caused by prediabetes causes great difficulties in human life, and the terrible thing is that the means to prevent the occurrence of this disease are very limited at present, Berberine has shown the potential to treat diabetes and cognitive dysfunction, but it still needs to be further explored to clarify the mechanism of its therapeutic effect. Therefore, the aim of this study was to investigate the effects and mechanisms of Berberine on prediabetes-induced cognitive dysfunction. Prediabetes rat model was induced by a high-fat diet and a normal diet was used as a control. They were fed for 20 weeks. At week 13, the model rats were given 100 mg/kg Berberine by gavage for 7 weeks. The cognitive function of rats was observed. At the same time, OGTT, fasting blood glucose, blood lipids, insulin and other metabolic parameters, oxidative stress, and apoptosis levels were measured. The results showed that the model rats showed obvious glucose intolerance, elevated blood lipids, and insulin resistance, and the levels of oxidative stress and apoptosis were significantly increased. However, after the administration of Berberine, the blood glucose and lipid metabolism of prediabetic rats were significantly improved, and the oxidative stress level and apoptosis level of hippocampal tissue were significantly reduced. In conclusion, Berberine can alleviate the further development of diabetes in prediabetic rats, reduce oxidative stress and apoptosis in hippocampal tissue, and improve cognitive impairment in prediabetic rats.
Collapse
Affiliation(s)
- Lan Wu
- Health Management Center, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Xiang-Jian Meng
- Department of Endocrinology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Tian-Bao Xu
- Mathematics Teaching and Research Group, The High School Affiliated to Anhui Normal University, Wuhu, Anhui Province, China
| | - Xian-Cui Zhang
- Health Management Center, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Yong Zhou
- Health Management Center, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhu-Feng Tong
- Department of General Practice, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Jing-Han Jiang
- Department of General Practice, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| |
Collapse
|
4
|
Chen HM, Huang CN, Lin RT, Su BY. The impact of neuropsychological functions on self-care/self-management of type 2 diabetes in middle-aged people: a scoping review and meta-analysis. Expert Rev Endocrinol Metab 2023; 18:525-540. [PMID: 37815866 DOI: 10.1080/17446651.2023.2268171] [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: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION This study aimed to investigate the impact of neuropsychological functions on self-care/self-management in middle-aged individuals with type 2 diabetes (T2DM). AREAS COVERED A comprehensive literature search was conducted from January 2012 to April 2023 across multiple databases. Ten articles were included in the scoping review, and 3 articles were included in the meta-analysis. The findings consistently indicated an association between reduced neuropsychological functions and poor self-care/self-management in this population. Memory functions, executive functions, and other domains were found to be significantly related to self-care/self-management, including diet management, exercise, blood glucose monitoring, and foot care. EXPERT OPINION This study highlights the importance of considering neuropsychological factors in understanding and improving diabetes management outcomes. The findings underscore the need for comprehensive neuropsychological assessments and the development of targeted interventions to address specific vulnerable domains. Future research should focus on elucidating underlying mechanisms, addressing methodological inconsistencies, and exploring the effectiveness of interventions targeting neuropsychological impairments. Incorporating technology and personalized approaches into diabetes management can enhance self-care/self-management and clinical outcomes in individuals with T2DM.
Collapse
Affiliation(s)
- Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ning Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ro-Ting Lin
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung-Shan Medical University, Taichung, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
5
|
Maimaitituerxun R, Chen W, Xiang J, Xie Y, Kaminga AC, Wu XY, Chen L, Yang J, Liu A, Dai W. The use of nomogram for detecting mild cognitive impairment in patients with type 2 diabetes mellitus. J Diabetes 2023; 15:448-458. [PMID: 37057310 PMCID: PMC10172024 DOI: 10.1111/1753-0407.13384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/09/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is highly prevalent worldwide and may lead to a higher rate of cognitive dysfunction. This study aimed to develop and validate a nomogram-based model to detect mild cognitive impairment (MCI) in T2DM patients. METHODS Inpatients with T2DM in the endocrinology department of Xiangya Hospital were consecutively enrolled between March and December 2021. Well-qualified investigators conducted face-to-face interviews with participants to retrospectively collect sociodemographic characteristics, lifestyle factors, T2DM-related information, and history of depression and anxiety. Cognitive function was assessed using the Mini-Mental State Examination scale. A nomogram was developed to detect MCI based on the results of the multivariable logistic regression analysis. Calibration, discrimination, and clinical utility of the nomogram were subsequently evaluated by calibration plot, receiver operating characteristic curve, and decision curve analysis, respectively. RESULTS A total of 496 patients were included in this study. The prevalence of MCI in T2DM patients was 34.1% (95% confidence interval [CI]: 29.9%-38.3%). Age, marital status, household income, diabetes duration, diabetic retinopathy, anxiety, and depression were independently associated with MCI. Nomogram based on these factors had an area under the curve of 0.849 (95% CI: 0.815-0.883), and the threshold probability ranged from 35.0% to 85.0%. CONCLUSIONS Almost one in three T2DM patients suffered from MCI. The nomogram, based on age, marital status, household income, duration of diabetes, diabetic retinopathy, anxiety, and depression, achieved an optimal diagnosis of MCI. Therefore, it could provide a clinical basis for detecting MCI in T2DM patients.
Collapse
Affiliation(s)
- Rehanguli Maimaitituerxun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Wenhang Chen
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingsha Xiang
- Human Resources Department, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yu Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Atipatsa C Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Letao Chen
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| | - Jianzhou Yang
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| |
Collapse
|
6
|
Fiqri AM, Sjattar EL, Irwan AM. Cognitive Behavioral Therapy for self-care behaviors with type 2 diabetes mellitus patients: A systematic review. Diabetes Metab Syndr 2022; 16:102538. [PMID: 35753292 DOI: 10.1016/j.dsx.2022.102538] [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: 12/03/2021] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Self-care behavior is associated with the risk of microvascular and macrovascular complications. Self-care behaviors can be improved through positive thinking, attitude, and knowledge. Cognitive behavioral therapy (CBT) can be one of the interventions for improving self-care behaviors. However, the ideal model and duration of the intervention and an effective assessment instrument to measure the improvement in self-care behaviors remain unidentified. Therefore, this review aimed to assess the effectiveness of CBT, including its models, duration, and instruments, in improving self-care behaviors in patients with type 2 diabetes mellitus (T2DM). METHODS The Scopus, Cochrane Library, PubMed, EBSCO Host, Directory of Open Access Journals, GARUDA, Taylor & Francis, and Gray Literature databases were systematically searched to identify studies that were in English and published in 2011-2021. The quality of the identified articles was assessed using The Critical Appraisal Skill Programme. RESULTS We found 368 patients in seven randomized controlled trials. CBT was significantly effective in improving overall self-care behavior, including blood glucose monitoring, physical activity, and medication compliance. CONCLUSION Individual and group CBT interventions applied face-to-face, via telephone, and via internet show an increase in self-care behavior in patients with T2DM. The duration of treatment had a significant effect at 3 months to 1 year with 12-21 sessions. CBT is performed by a CBT licensed nurse or psychiatrist, nutritionist, CBT psychologist with experience in diabetes care, doctors, research students.
Collapse
Affiliation(s)
- Andi Muhammad Fiqri
- Post Graduate Nursing Program, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia
| | - Elly Lilianty Sjattar
- Medical Surgical Nursing Department, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia
| | - Andi Masyitha Irwan
- Gerontological Nursing Department, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia.
| |
Collapse
|
7
|
Luo A, Xie Z, Wang Y, Wang X, Li S, Yan J, Zhan G, Zhou Z, Zhao Y, Li S. Type 2 diabetes mellitus-associated cognitive dysfunction: Advances in potential mechanisms and therapies. Neurosci Biobehav Rev 2022; 137:104642. [PMID: 35367221 DOI: 10.1016/j.neubiorev.2022.104642] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 12/22/2022]
Abstract
Type 2 diabetes (T2D) and its target organ injuries cause distressing impacts on personal health and put an enormous burden on the healthcare system, and increasing attention has been paid to T2D-associated cognitive dysfunction (TDACD). TDACD is characterized by cognitive dysfunction, delayed executive ability, and impeded information-processing speed. Brain imaging data suggest that extensive brain regions are affected in patients with T2D. Based on current findings, a wide spectrum of non-specific neurodegenerative mechanisms that partially overlap with the mechanisms of neurodegenerative diseases is hypothesized to be associated with TDACD. However, it remains unclear whether TDACD is a consequence of T2D or a complication that co-occurs with T2D. Theoretically, anti-diabetes methods are promising neuromodulatory approaches to reduce brain injury in patients with T2D. In this review, we summarize potential mechanisms underlying TDACD and promising neurotropic effects of anti-diabetes methods and some neuroprotective natural compounds. Constructing screening or diagnostic tools and developing targeted treatment and preventive strategies would be expected to reduce the burden of TDACD.
Collapse
Affiliation(s)
- Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Zheng Xie
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Yue Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Xuan Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Shan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Jing Yan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Gaofeng Zhan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Zhiqiang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Yilin Zhao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Shiyong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| |
Collapse
|