The Relationship Of Serum Undercarboxylated Osteocalcin With Cognition In Male Type 2 Diabetes Patients

Objective: To study the the relationship of serum undercarboxylated osteocalcin(ucOC)with cognition in male type 2 diabetes(T2DM)patients,we detected serum levels of ucOC and evaluated cognitive performance of all subjects by Minimum Mental State Examination(MMSE)scale and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)scale in male T2DM patients.Methods: 196 male patients with T2DM cared at department of endocrinology of Tangshan Gongren hospital from March 2014 to September 2015 were recruited.Demographic datas including age,education,duration of diabetes and body mass index(BMI)were recorded;Clincal biochemical parameters including fasting plasma glucose(FPG),glycosylated hemoglobin A1c(HbA1c),total cholesterol(TC),triglycerides(TG),low density lipoprotein(LDL),high density lipoprotein(HDL)were collected.Serum levels of ucOC was analyzed by using enzyme-linked immunosorbent assay(ELISA).Cognitive performance of all subjects were evaluated cognitive performance of all subjects by Minimum Mental State Examination(MMSE)scale and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)scale.All subjects were divided into two group which were impaired cognition group and non-impaired cognition group depending on the scores of MMSE.General informations and RBANS scores were compared between aboved two groups;All patients were divided into two groups depending on serum ucOC levels which were low ucOC levels group and high ucOC levels group,general informations and RBANS scores of two groups were compared.Relationships of serum ucOC with general informations and RBANS scale scores in male type 2 diabetes patients were analysed.Results: 1.Comparisions between impaired cognition group and non-impaired cognition group:1)Comparisions of demographic datas and clincal biochemical parameters between two groups: Compared with non-impaired cognition group,patients of impaired cognition group were older,with lower levels of education and higher levels of HbA1 c.The differences were statistically significant(all P<0.05)(Shown in Table 1 and Fig.1).2)Comparision of serum levels of ucOC between two groups: Compared with non-impaired cognition group,patients of impaired cognition group had lower levels of ucOC(P<0.001).After adjusted effects of age,education,duration of diabetes,BMI,FPG,Hb A1 c,TC,TG,HDL and LDL,the difference between aboved two groups still existed(P<0.001)(Shown in Table 2 and Fig.1).2.Analysis of risk factors for cognitive deficits: After adjusted effects of age,education,duration of diabetes,BMI,FPG,HbA1 c,TC,TG,HDL,LDL and ucOC by Logistic analysis,we found that age(OR=2.117,P=0.006),education(OR=0.599,P=0.018),HbA1c(OR=1.294,P=0.018)and ucOC(OR=0.199,P<0.001)were independent risk factors for cognitive deficits in male T2DM patients(Shown in Table 3).3.Comparisions of RBANS scale scores between two groups: Compared with non-impaired cognition group,patients of impaired cognition group had lower scores on immediate memory,visuospatial/constructional,language,attention,delayed memory indexes and total scores,the differences were statistically significant(all P<0.05)(Shown in Table 4 and Fig.2).4.Comparisions between low ucOC levels group and high ucOC levels group:1)Comparisions of demographic datas and clincal biochemical parameters between two groups: Compared with high ucOC levels group,patients of low ucOC levels group had higher levels of HbA1 c and lower levels of HDL(all P<0.05)(Shown in Table 5 and Fig.3).2)Comparisions of RBANS scale scores between two groups: Compared with high ucOC levels group,patients of low ucOC levels group had lower scores on immediate memory,visuospatial/constructional,language,attention,delayed memory indexes and total scores,the differences were statistically significant(all P<0.05).After adjusted effects of age,education,duration of diabetes,BMI,FPG,HbA1 c,TC,TG,HDL and LDL,only the difference on delayed memory indexes scores and total scores between aboved two groups still existed(all P<0.05)(Shown in Table 6 and Fig.4).5.Relationships of ucOC with demographic datas and clincal biochemical parameters: In male T2DM patients,Serum ucOC was significantly inversely correlated with HbA1c(r=-0.227,P=0.001),but postively correlated with HDL(r=0.147,P=0.039).After adjusted effects of age,education,diabetes duration,BMI,FPG,Hb A1 c,TC,TG,HDL and LDL by Stepwise regression analysis,the relationships among ucOC,HbA1 c and HDL still existed(all P<0.05)(Shown in Table 7 and Fig.5).6.Relationships of ucOC with RBANS scale scores: serum ucOC was positively correlated with RBANS scores without visuospatial/constructional in male T2DM patients,including immediate memory(r=0.276,P<0.001),language(r=0.237,P=0.001),attention(r=0.245,P=0.001),delayed memory(r=0.298,P<0.001)and total scores(r=0.327,P<0.001).Stepwise regression analysis showed that for male T2DM patients,after been adjusted the effects of age,education,diabetes duration,BMI,FPG,HbA1 c,TC,TG,HDL and LDL,serum ucOC was remained postively correlated with immediate memory(β=3.352,P=0.005),language(β=2.510,P=0.001),attention(β=3.092,P=0.008),delayed memory(β=3.202,P=0.001)and total scores(β=3.260,P<0.001)(Shown in Table 8 and Fig.6).Conclusions:1 Male T2DM patients with impaired cognition had lower levels of ucOC.2 Serum ucOC was postively correlated with cognitive performance in male T2DM patients.3 It suggests that decreased serum ucOC may play a role in cognitive impairment of male patients with T2DM.