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Satuli-Autere S, Harjutsalo V, Eriksson MI, Hägg-Holmberg S, Öhman H, Claesson TB, Groop PH, Thorn LM. Increased incidence of neurodegenerative diseases in Finnish individuals with type 1 diabetes. BMJ Open Diabetes Res Care 2024; 12:e004024. [PMID: 39242121 PMCID: PMC11381727 DOI: 10.1136/bmjdrc-2024-004024] [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: 01/12/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION Diabetes is linked to neurodegenerative diseases (NDs), but data in type 1 diabetes are scarce. Our aim was to assess the standardized incidence ratios (SIRs) of different NDs in type 1 diabetes, and to evaluate the impact of diabetic vascular complications and age at diabetes onset. RESEARCH DESIGN AND METHODS In this observational cohort study, we included 4261 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy study, and 11 653 matched population-based controls without diabetes. NDs were identified from registers until the end of 2017. Diabetic complications were assessed at the baseline study visit. SIRs were calculated from diabetes onset, except for impact of complications that was calculated from baseline study visit. RESULTS The SIRs for NDs were increased in type 1 diabetes: any dementia 2.24 (95% CI 1.79 to 2.77), Alzheimer's disease 2.13 (95% CI 1.55 to 2.87), vascular dementia 3.40 (95% CI 2.08 to 5.6), other dementias 1.70 (95% CI 1.22 to 2.31), and Parkinson's disease 1.61 (95% CI 1.04 to 2.37). SIR showed a twofold increased incidence already in those without albuminuria (1.99 (1.44-2.68)), but further increased in presence of diabetic complications: kidney disease increased SIR for Alzheimer's disease, while cardiovascular disease increased SIR for both Alzheimer's disease and other dementias. Diabetes onset <15 years, compared with ≥15 years, increased SIR of Alzheimer's disease, 3.89 (2.21-6.35) vs 1.73 (1.16-2.48), p<0.05, but not the other dementias. CONCLUSIONS ND incidence is increased 1.7-3.4-fold in type 1 diabetes. The presence of diabetic kidney disease and cardiovascular disease further increased the incidence of dementia.
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Affiliation(s)
- Susanna Satuli-Autere
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Marika I Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Stefanie Hägg-Holmberg
- Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- Department of Geriatrics, Helsinki University Central Hospital, Helsinki, Finland
| | - Tor-Björn Claesson
- Folkhälsan Research Center, Helsinki, Finland
- Departmet of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Lena M Thorn
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Bacha AA, Suhail M, Awwad FA, Ismail EAA, Ahmad H. Role of dietary fiber and lifestyle modification in gut health and sleep quality. Front Nutr 2024; 11:1324793. [PMID: 38633603 PMCID: PMC11022964 DOI: 10.3389/fnut.2024.1324793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
Dietary fiber has an immense role in the gut microbiome by modulating juvenile growth, immune system maturation, glucose, and lipid metabolism. Lifestyle changes might disrupt gut microbiota symbiosis, leading to various chronic diseases with underlying inflammatory conditions, obesity, and its associated pathologies. An interventional study of 16 weeks examined the impact of psyllium husk fiber with and without lifestyle modification on gut health and sleep quality in people with central obesity (men = 60 and women = 60), those aged from 40 to 60 years, those having WC ≥ 90 cm (men) and WC ≥ 80 cm (women), and no history of any chronic disease or regular medication. The participants were subgrouped into three intervention groups, namely, the psyllium husk fiber (PSH) group, the lifestyle modification (LSM) group, and the LSM&PSH group and control group with equal gender bifurcation (men = 15 and women = 15). A 24-h dietary recall, gastrointestinal tract (GIT) symptoms, and sleep quality analysis data were collected on validated questionnaires. The analyses of variance and covariance were used for baseline and post-intervention, respectively. Student's t-test was applied for pre- and post-intervention changes on the variable of interest. The intervention effect on GIT health was highly significant (P < 0.001). The mean GIT scores of the LSM, PSH, and LSM&PSH groups were 2.99 ± 0.14, 2.49 ± 0.14, and 2.71 ± 0.14, respectively, compared to the mean GIT scores of the control group. No significant (P = 0.205) effect of either intervention was observed on sleep quality. The study concluded that psyllium husk fiber significantly improved the GIT symptoms, while no significant effect of the intervention was observed on sleep quality analysis.
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Affiliation(s)
- Amjad Ali Bacha
- Department of Human Nutrition, The University of Agriculture Peshawar, Peshawar, Pakistan
- Amir Muhammad Khan Campus Mardan, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Muhammad Suhail
- Amir Muhammad Khan Campus Mardan, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Fuad A. Awwad
- Department of Quantitative Analysis, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Emad A. A. Ismail
- Department of Quantitative Analysis, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Hijaz Ahmad
- Center for Applied Mathematics and Bioinformatics, Gulf University for Science and Technology, Mishref, Kuwait
- Department of Computer Science and Mathematics, Lebanese American University, Beirut, Lebanon
- Section of Mathematics, International Telematic University Uninettuno, Rome, Italy
- Near East University, Operational Research Center in Healthcare, Nicosia, Türkiye
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3
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Liu X, Xu P, Wei R, Cheng B, Sun L, Yang L, Chen G. Gender-and age-specific associations of sleep duration and quality with cognitive impairment in community-dwelling older adults in Anhui Province, China. Front Public Health 2024; 11:1047025. [PMID: 38249381 PMCID: PMC10796606 DOI: 10.3389/fpubh.2023.1047025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Objective To examine associations of sleep duration and quality with cognitive impairment in older adults and the moderating role of gender and age in these associations. Methods This community-based cross-sectional study included 4,837 participants aged 60 years and above. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE), and the participants were grouped based on the presence of cognitive impairment. The duration and quality of sleep were assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression models were used to analyze associations of sleep duration and quality with cognitive impairment. The role of age and gender in these associations have also been explored. Results The age (mean ± SD) of the participants was 71.13 ± 5.50 years. Of all older adults, 1,811 (37.44%) were detected as cognitive impairment, and 1755 (36.8%) had poor sleep quality. Among those with cognitive impairment, 51.09% were female. The proportion of the participants with cognitive impairment is significantly higher in those with symptoms of depression (49.73%, 273/549) (χ2 = 41.275, p < 0.001) than in those without depressive symptoms. After adjustment for multiple confounding factors and the crucial covariate (depressive symptoms), the odds ratios (OR) (95% confidence interval [CI]) of cognitive impairment (with 7-7.9 h regarded as the reference group) for individuals with a sleep duration of <6, 6-6.9, 8-8.9, and ≥ 9 h were 1.280 (1.053-1.557), 1.425 (1.175-1.728), 1.294 (1.068-1.566), and 1.360 (1.109-1.668), respectively. Subgroup analysis showed a V-shaped association between night sleep duration and cognitive impairment in males (p ≤ 0.05), and the association was stronger for individuals aged 60-80 years. With regard to sleep quality, the fully adjusted OR (95%CI) of cognitive impairment were 1.263 (1.108-1.440). According to scores of subscales in the PSQI, daytime dysfunction was associated with an increased risk of cognitive impairment (OR: 1.128, 95%CI: 1.055-1.207). Subgroup analysis also revealed a statistically significant correlation between poor sleep quality (including daytime dysfunction) and cognitive impairment in different gender and age groups, with the association being stronger in females (OR: 1.287, 95%CI: 1.080-1.534) and those aged 81-97 years (OR: 2.128, 95%CI: 1.152-3.934). For cognitive impairment, the group aged 81-97 years with daytime dysfunction was associated with a higher odds ratio than other age groups. Conclusion The present study showed that inadequate or excessive sleep was associated with cognitive impairment, especially in males, who exhibited a V-shaped association. Cognitive impairment was also associated with poor sleep quality as well as daytime dysfunction, with females and individuals aged 81-97 years exhibiting the strongest association.
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Affiliation(s)
- Xuechun Liu
- Department of Neurology, The Second People’s Hospital of Hefei, Hefei, China
| | - Peiru Xu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Rong Wei
- Outpatient Department of the Second Hospital of Anhui Medical University, Hefei, China
| | - Beijing Cheng
- School of Public Health, Anhui Medical University, Hefei, China
| | - Liang Sun
- Fuyang Center of Disease Control and Prevention, Fuyang, China
| | - Linsheng Yang
- School of Public Health, Anhui Medical University, Hefei, China
| | - Guihai Chen
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, China
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Chen HF, Jiang JY, Chen MH, Lin R, Jerence SWO, Chang CH, Chou CC. Gender differences in cognitive function and its associated factors among older adults with type 2 diabetes. Geriatr Nurs 2023; 52:165-171. [PMID: 37354756 DOI: 10.1016/j.gerinurse.2023.05.017] [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: 03/10/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
Diabetes is widely prevalent among older people and can influence accelerated cognitive decline. Gender-based disparities may contribute to variations in cognitive decline. This study examined gender differences in cognitive function and associated factors among older adults with diabetes. A cross-sectional study was conducted involving 318 Taiwanese older adults with type 2 diabetes. Demographic, health, and diabetes-related data were collected, and cognitive neuropsychological tests were evaluated. Compared to men, women with diabetes showed significantly poorer performance in global cognitive function and executive function. Age, years of education, sleep quality, and HbA1c were correlated with domains of cognitive function in men, whereas age, years of education, depressive symptoms, HbA1c, and duration of diabetes were associated with domains of cognitive function among women. Nurses should recognize gender differences in factors associated with cognitive function in older adults with diabetes and should develop individualized interventions to improve patients' cognitive function.
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Affiliation(s)
- Hua-Fen Chen
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan
| | - Ju Ying Jiang
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Hsiu Chen
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Biomedical Engineering, Ming Chuang University, Taoyuan, Taiwan
| | - Rong Lin
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Seng Wei Ooi Jerence
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chin-Huan Chang
- Division of Endocrinology & Metabolism, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Chen Chou
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Bongiorno C, Moscatiello S, Baldari M, Saudelli E, Zucchini S, Maltoni G, Ribichini D, Bruco A, Lo Preiato V, Laffi G, Pagotto U, Di Dalmazi G. Sleep quality and sex-related factors in adult patients with immune-mediated diabetes: a large cross-sectional study. Acta Diabetol 2023; 60:663-672. [PMID: 36800003 PMCID: PMC9936122 DOI: 10.1007/s00592-023-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
AIM To analyze sleep quality and its relationships with clinical and biochemical features in a large cohort of adults with autoimmune diabetes. METHODS We administered to 553 patients with autoimmune diabetes the questionnaires: Pittsburgh Sleep Quality Index (PSQI), diabetes distress scale, diabetes-related quality of life and diabetes treatment satisfaction questionnaire. We excluded patients with missing HbA1c ± 4 months from PSQI administration or incorrect PSQI compilation (n = 110). RESULTS Altered sleep quality was recorded in 142/443 subjects (32%), insufficient total sleep time in 177/443 (40%). The altered sleep quality group had higher HbA1c (median 56 mmol/mol [interquartile range-IQR 49-62] vs 59 [IQR 52-68]; P < 0.001), higher average HbA1c in the previous 36 months (59 mmol/mol [IQR 54-68] vs 56 [IQR 51-62]; P < 0.001), and more individuals with HbA1c > 53 mmol/mol (74.6% vs 62.8%; P = 0.014). Diabetes duration (P = 0.63), type of insulin delivery (P = 0.48) and glucose monitoring (P = 0.35) were uninfluential. Patients with altered sleep quality showed higher prevalence of autoimmune (42 vs 28%; P = 0.005) and mental diseases (12 vs 4%; P = 0.002); there were greater emotional distress, and lower quality of life and treatment satisfaction (P < 0.001 for all), irrespective of sex. Men with altered sleep quality had higher HbA1c and prevalence of autoimmune diseases. Women showed greater prevalence of psychiatric disorders. Average HbA1c of the previous 36 months, autoimmune or psychiatric disorders were independent predictive factors for altered sleep quality. CONCLUSION One-third of the patients with autoimmune diabetes showed altered sleep quality, which associates with worse glycemic control, and autoimmune and mental disorders, with sex-specific differences.
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Affiliation(s)
- Claudio Bongiorno
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Moscatiello
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Michele Baldari
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Enrico Saudelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit,, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giulio Maltoni
- Pediatric Unit,, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Danilo Ribichini
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alessia Bruco
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gilberto Laffi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Jin CY, Yu SW, Yin JT, Yuan XY, Wang XG. Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review. Heliyon 2022; 8:e10073. [PMID: 35991978 PMCID: PMC9389196 DOI: 10.1016/j.heliyon.2022.e10073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence. Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus. Duration and age; Education and gender and Glycemic states. Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c. Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.
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Affiliation(s)
- Chen-Yang Jin
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Shi-Wen Yu
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Jun-Ting Yin
- The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116027, PR China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 116044, PR China
- Department of Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
- Corresponding author.
| | - Xu-Gang Wang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, PR China
- Corresponding author.
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Abstract
PURPOSE OF REVIEW To review the relationship between sleep and hypoglycemia, sleep characteristics, and their associations with glycemic control in persons with type 1 diabetes (T1D). The effects of sleep interventions and diabetes technology on sleep are summarized. RECENT FINDINGS Nocturnal hypoglycemia affects objective and subjective sleep quality and is related to behavioral, psychological, and physiological factors. Sleep disturbances are common, including inadequate sleep, impaired sleep efficiency, poor subjective satisfaction, irregular timing, increased daytime sleepiness, and sleep apnea. Some have a bidirectional relationship with glycemic control. Preliminary evidence supports sleep interventions (e.g., sleep extension and sleep coach) in improving sleep and glycemic control, while diabetes technology use could potentially improve sleep. Hypoglycemia and sleep disturbances are common among persons with T1D. There is a need to develop sleep promotion programs and test their effects on sleep, glucose, and related outcomes (e.g., self-care, psychological health).
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ghada Mohammed Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott Ave, Suite 625E, M/C 640, IL, 60612, Chicago, USA.
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Fu X, Wang J, Zhang P, Du H, Wu S, Zhang H, Xiong W. Diagnosis of TCM symptoms and analysis of risk factors of mild cognitive impairment in patients with type 2 diabetes mellitus. Am J Transl Res 2021; 13:12980-12987. [PMID: 34956514 PMCID: PMC8661213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the diagnosis of traditional Chinese medicine (TCM) syndrome and analyze the risk factors of mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus (T2DM). METHODS 141 T2DM patients, who were hospitalized in department of endocrinology of our hospital from February 2020 to December 2020, were chosen as research subjects. The patients were divided into an observation group (n=65, T2DM with MCI) and a control group (n=76, T2DM with normal cognitive function) according to the Montreal Cognitive Assessment (MoCA) score and diagnostic criteria of MCI. Pearson correlation analysis was used to study the correlation between MoCA score and influencing factors, and multiple logistic regression analyses were applied to analyze the risk factors of T2DM patients. RESULTS Deficiency of kidney essence (34/65, 52.31%) and phlegm obstructing orifices (16/65, 2.62%) were common in T2DM patients with MCI. The observation group had apparently lower MoCA scores than the control group (23.46±3.12 points vs. 27.39±2.56 points, t=8.2150, P=0.0000). According to the results of multivariate logistic regression analysis, age, course of diabetes, homocysteine (HCY) and glycosylated hemoglobin (HbAlc) were the independent risk factors of MCI, and the education level was a protective factor. CONCLUSION Mental deficiency and phlegm obstruction are common in T2DM patients complicated with MCI. The factors such as age, diabetes course, education degree, HCY and HbAlc are closely related to MCI. The occurrence of MCI in T2DM patients can be prevented by improving the education degree of patients, effective control of blood glucose and reduction of HCY level.
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Affiliation(s)
- Xudong Fu
- Department of Health Medicine, Liaocheng People’s HospitalLiaocheng 252000, Shandong, China
| | - Jiajia Wang
- Department of Endocrinology, Gaotang County People’s HospitalGaotang 252800, Shandong, China
| | - Ping Zhang
- Department of Gynecology, Zhangqiu District People’s HospitalJinan 252200, Shandong, China
| | - Hongquan Du
- Department of Endocrinology, Liaocheng People’s HospitalLiaocheng 252000, Shandong, China
| | - Suqin Wu
- Department of Endocrinology, Heze City Chinese Medicine HospitalHeze 274000, Shandong, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong First Medical University Affiliated Provincial Hospital, Shandong University Affiliated Provincial HospitalJinan 250021, Shandong, China
| | - Wen Xiong
- Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical SciencesJinan 250062, Shandong, China
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Perkins BA, Lovblom LE, Lanctôt SO, Lamb K, Cherney DZI. Discoveries from the study of longstanding type 1 diabetes. Diabetologia 2021; 64:1189-1200. [PMID: 33661335 DOI: 10.1007/s00125-021-05403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Award programmes that acknowledge the remarkable accomplishments of long-term survivors with type 1 diabetes have naturally evolved into research programmes to determine the factors associated with survivorship and resistance to chronic complications. In this review, we present an overview of the methodological sources of selection bias inherent in survivorship research (selection of those with early-onset diabetes, incidence-prevalence bias and bias from losses to follow-up in cohort studies) and the breadth and depth of literature focusing on this special study population. We focus on the learnings from the study of longstanding type 1 diabetes on discoveries about the natural history of insulin production loss and microvascular complications, and mechanisms associated with them that may in future offer therapeutic targets. We detail descriptive findings about the prevalence of preserved insulin production and resistance to complications, and the putative mechanisms associated with such resistance. To date, findings imply that the following mechanisms exist: strategies to maintain or recover beta cells and their function; activation of specific glycolytic enzymes such as pyruvate kinase M2; modification of AGE production and processing; novel mechanisms for modification of renin-angiotensin-aldosterone system activation, in particular those that may normalise afferent rather than efferent renal arteriolar resistance; and activation and modification of processes such as retinol binding and DNA damage checkpoint proteins. Among the many clinical and public health insights, research into this special study population has identified putative mechanisms that may in future serve as therapeutic targets, knowledge that likely could not have been gained without studying long-term survivors.
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Affiliation(s)
- Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Leif Erik Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sebastien O Lanctôt
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Krista Lamb
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Moran C, Gilsanz P, Beeri MS, Whitmer RA, Lacy ME. Sex, diabetes status and cognition: findings from the study of longevity in diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e001646. [PMID: 33509934 PMCID: PMC7845709 DOI: 10.1136/bmjdrc-2020-001646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Women comprise two-thirds of people with dementia, making female sex a significant dementia risk factor. Both type 1 diabetes (T1D) and type 2 diabetes (T2D) are known dementia risk factors with an increasing global incidence. Understanding whether subtle sex differences persist in cognitive function prior to dementia in the context of diabetes may help elucidate the magnitude of sex effects on dementia risk. RESEARCH DESIGN AND METHODS We examined cross-sectional data from the Study of Longevity in Diabetes (SOLID), a prospective cohort study of members of Kaiser Permanente Northern California aged 60 years and older with T1D (n=758), T2D (n=232) and without either T1D or T2D (n=247). We used factor analysis to generate summary scores of cognitive domains and used regression analyses to examine the associations between sex and cognition adjusting for sociodemographic and cardiovascular confounders. RESULTS We included 1237 participants (630 women and 607 men) with mean age 68 years. By design, the distribution of men and women in T1D, T2D and no diabetes was similar. Women had better cognitive performance than men in global cognition (β=0.21, 95% CI 0.16 to 0.26), language (β=0.08, 95% CI 0.004 to 0.15), executive function (β=0.13, 95% CI 0.05 to 0.20), episodic verbal memory (β=0.68, 95% CI 0.59 to 0.77) and attention (β=0.20, 95% CI 0.11 to 0.28) but not in episodic visual memory (β=0.006, 95% CI -0.07 to 0.09) adjusting for age and education independent of diabetes status. We did not find an interaction between sex and diabetes status for any of the cognitive outcomes. CONCLUSIONS Women in late mid-life have better cognitive performance than men in many cognitive domains independent of the presence of T1D or T2D. Further work is required to understand whether these differences change over time or in older cohorts and to understand their relationship to subsequent dementia.
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Affiliation(s)
- Chris Moran
- Academic Unit, Peninsula Clinical School, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Peninsula Health, Frankston, Victoria, Australia
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Michal S Beeri
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Joseph Sagol Neuroscience, Sheba Medical Center, Tel Hashomer, Israel
| | - Rachel A Whitmer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Epidemiology, University of California Davis School of Medicine, Davis, California, USA
| | - Mary E Lacy
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
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