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Ye M, Yang Q, Zhang L, Song H, Fu Q, Qian J, Xie H, Yuan A. Effect of hypoglycemic events on cognitive function in individuals with type 2 diabetes mellitus: a dose-response meta-analysis. Front Neurol 2024; 15:1394499. [PMID: 39193149 PMCID: PMC11347434 DOI: 10.3389/fneur.2024.1394499] [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: 03/01/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is widely acknowledged as a vital warning sign contributing to cognitive dysfunction. However, there is still a lack of consensus on whether hypoglycemic events resulting from poor glycemic control increase the risk of cognitive dysfunction in people with diabetes, and the potential dose-response correlation between hypoglycemic events and cognitive dysfunction remains unexplored. The primary objective of the current study was to assess the contribution of hypoglycemic events to cognitive dysfunction in T2DM patients and the dose-response correlation between the two. Methods A comprehensive search of nine major databases was executed from inception to May 2023. We screened all observational studies examining the connection between hypoglycemia and cognitive dysfunction. The DerSimonian-Laird method was used to compute the combined risk ratio (RR) and its 95% confidence interval (CI). Additionally, dose-response analysis was employed to investigate the correlation between the frequency of hypoglycemia and the likelihood of cognitive dysfunction. Results A total of 30 studies of different levels in 17 articles with 3,961,352 participants were included in this review. The pooled RR for the connection of hypoglycemia and the likelihood of cognitive dysfunction was 1.47 (95% CI: 1.35-1.60). Subgroup analyses showed that the pooled RR for the likelihood of cognitive dysfunction was 1.20 (95% CI: 1.11-1.31) for one episode of hypoglycemia, 1.41 (95% CI: 1.05-1.88) for two episodes of hypoglycemia, and 1.62 (95% CI: 1.20-2.91) for three or more episodes of hypoglycemia. Dose-response analysis showed a linear dose-response relationship between hypoglycemia and the likelihood of cognitive dysfunction (exp (b) = 1.178694, z = 7.12, p < 0.001). Conclusion Our investigations demonstrated a 47% heightened likelihood of cognitive dysfunction in individuals with hypoglycemia compared to those without. Furthermore, the likelihood of cognitive dysfunction climbed by 17.87% for every subsequent episode of hypoglycemia. Therefore, long-term monitoring of blood glucose, periodic screening of cognitive function, and moderate health education should be encouraged, which will be beneficial for people with diabetes to prevent hypoglycemic events and cognitive dysfunction. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, CRD42023432352.
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Affiliation(s)
- Min Ye
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Qiqi Yang
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Lele Zhang
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Hudie Song
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Qin Fu
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jun Qian
- First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Hongyu Xie
- Acupuncture and Rehabilitation Department, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Aihong Yuan
- Acupuncture and Rehabilitation Department, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
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Cao HL, Meng YJ, Zhang YM, Deng W, Guo WJ, Li ML, Li T. The volume of gray matter mediates the relationship between glucolipid metabolism and neurocognition in first-episode, drug-naïve patients with schizophrenia. J Psychiatr Res 2024; 172:402-410. [PMID: 38458112 DOI: 10.1016/j.jpsychires.2024.02.055] [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: 10/31/2023] [Revised: 02/17/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
We aimed to examine the hypotheses that glucolipid metabolism is linked to neurocognition and gray matter volume (GMV) and that GMV mediates the association of glucolipid metabolism with neurocognition in first-episode, drug-naïve (FEDN) patients with schizophrenia. Parameters of glucolipid metabolism, neurocognition, and magnetic resonance imaging were assessed in 63 patients and 31 controls. Compared to controls, patients exhibited higher levels of fasting glucose, triglyceride, and insulin resistance index, lower levels of cholesterol and high-density lipoprotein cholesterol, poorer neurocognitive functions, and decreased GMV in the bilateral insula, left middle occipital gyrus, and left postcentral gyrus. In the patient group, triglyceride levels and the insulin resistance index exhibited a negative correlation with Rapid Visual Information Processing (RVP) mean latency, a measure of attention within the Cambridge Neurocognitive Test Automated Battery (CANTAB), while showing a positive association with GMV in the right insula. The mediation model revealed that triglyceride and insulin resistance index had a significant positive indirect (mediated) influence on RVP mean latency through GMV in the right insula. Glucolipid metabolism was linked to both neurocognitive functions and GMV in FEDN patients with schizophrenia, with the effect pattern differing from that observed in chronic schizophrenia or schizophrenia comorbid with metabolic syndrome. Moreover, glucolipid metabolism might indirectly contribute to neurocognitive deficits through the mediating role of GMV in these patients.
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Affiliation(s)
- Hai-Ling Cao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ya-Jing Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ya-Min Zhang
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wan-Jun Guo
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming-Li Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou, 311121, China; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, 310058, China.
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Liu Y, Jiang Y, Du W, Gao B, Gao J, Hu S, Song Q, Wang W, Miao Y. White matter microstructure alterations in type 2 diabetes mellitus and its correlation with cerebral small vessel disease and cognitive performance. Sci Rep 2024; 14:270. [PMID: 38167604 PMCID: PMC10762026 DOI: 10.1038/s41598-023-50768-z] [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] [Received: 02/28/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Microstructural abnormalities of white matter fiber tracts are considered as one of the etiology of diabetes-induced neurological disorders. We explored the cerebral white matter microstructure alteration accurately, and to analyze its correlation between cerebral small vessel disease (CSVD) burden and cognitive performance in type 2 diabetes mellitus (T2DM). The clinical-laboratory data, cognitive scores [including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), California verbal learning test (CVLT), and symbol digit modalities test (SDMT)], CSVD burden scores of the T2DM group (n = 34) and healthy control (HC) group (n = 21) were collected prospectively. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along primary white matter fiber tracts. Diffusion tensor images (DTI) metrics and 100 nodes of white matter fiber tracts between groups were compared. Multiple regression analysis was used to analyze the relationship between DTI metrics and cognitive scores and CSVD burden scores. For fiber-wise and node-wise, DTI metrics in some commissural and association fibers were increased in T2DM. Some white matter fiber tracts DTI metrics were independent predictors of cognitive scores and CSVD burden scores. White matter fiber tracts damage in patients with T2DM may be characterized in specific location, especially commissural and association fibers. Aberrational specific white matter fiber tracts are associated with visuospatial function and CSVD burden.
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Affiliation(s)
- Yangyingqiu Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
- Department of Radiology, Zibo Central Hospital, 54 Gongqingtuan Road, Zhangdian, Zibo, China
| | - Yuhan Jiang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Wei Du
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Bingbing Gao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Jie Gao
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Shuai Hu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Weiwei Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China.
| | - Yanwei Miao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China.
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Castro Conde A, Marzal Martín D, Campuzano Ruiz R, Fernández Olmo MR, Morillas Ariño C, Gómez Doblas JJ, Gorriz Teruel JL, Mazón Ramos P, García-Moll Marimon X, Soler Romeo MJ, León Jiménez D, Arrarte Esteban V, Obaya Rebollar JC, Escobar Cervantes C, Gorgojo Martínez JJ. Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes. J Clin Med 2023; 12:3925. [PMID: 37373620 PMCID: PMC10299569 DOI: 10.3390/jcm12123925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | - Pilar Mazón Ramos
- Cardiology Department, Complejo Hospitalario Universitario Santiago de Compostela, 15706 A Coruña, Spain;
| | | | | | - David León Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | | | | | | | - Juan J. Gorgojo Martínez
- Department of Endocrinology and Nutrition, University Hospital Fundación Alcorcón, 28922 Madrid, Spain;
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