Analysis Of Related Risk Factors Between T2DM And Cognitive Function

Objective:Explore the risk factors of type 2 diabetes mellitus(T2DM)leading to impaired cognitive function,provide corresponding basis for early recognition and intervention,and help patients delay the occurrence of cognitive impairment.Methods:This study was carried out in the Endocrinology Department of the Second Affiliated Hospital of Dalian Medical University from October 2019 to March2021.The age of the subjects was between 28~78 years old.A total of 185 subjects were enrolled,of which 148 were T2DM patients.Firstly,the cognitive function of T2DM and non-diabetic patients was compared by the method of paired analysis to verify the relationship between T2DM and cognitive impairment.Subsequently,the T2DM patients were divided into groups based on the results of the Montreal Cognitive Assessment Scale(MoCA): T2DM combined with cognitive impairment group(T2DMMCI group)(<26 points),a total of 94 cases;T2DM without cognitive impairment group(T2DM-NCI group)(≥26 points)a total of 54 cases.This study requires detailed statistics on the basic information of the included research subjects: gender,age,education,smoking,drinking,etc.,history of hypertension,body mass index(BMI),waist circumference,history of diabetes,and history of hypoglycemia.All subjects need to complete the Montreal Cognitive Assessment Scale(MoCA),brain 3.0 magnetic resonance examination(MRI),and ophthalmoscope.In addition,the venous blood of all subjects was collected to detect the following indicators: glucose metabolism indicators(FBG,Hb A1c),islet function indicators [CP(0,1,2h),Ins(0,1,2h)],lipid metabolism indicators(TC,TG,HDL-C,LDL-C,Apo AⅠ,Apo B),liver biochemical function(ALT,AST),renal function(Cr),thyroid function(FT3,FT4,TSH,TGAb,TPOAb),inflammatory factors(IL-1β,IL-2R,IL-6,IL-8,IL-10,TNF-α).Urine specimens were collected for testing KET and U-ALB/Cr.Calculate HOMA-IR and HOMA-β at the same time.The above-mentioned basic information,brain 3.0 MRI results,ophthalmoscope examination results,blood and urine test indicators were compared between the T2DM-MCI group and the T2DM-NCI group.Performing statistical analysis on the results of the above indicators.For statistically significant indicators,further improved the Spearman correlation to determine the relationship between the MoCA scale score and each indicator.Finally,a binomial logistic regression analysis was performed on significantly related indicators to explore the independent risk factors for MCI in patients with T2DM.Results:1.T2DM group and control group: MoCA score(Z=-2.26,P=0.024),history of hypertension,glucose metabolism index,partial islet function index,HOMAIR,HOMA-β,the above indexes were statistically different between the two groups.There were no significant differences in thyroid function,renal function,liver biochemical function,lipid metabolism index,Ins(0h),C-P(0h),inflammatory factors and brain 3.0 MRI.2.T2DM-MCI group and T2DM-NCI group: age(t=3.09,P=0.003),gender(χ2=6.33,P=0.012),years of education(Z=-6.04,P=0.000),MoCA score(Z=-10.04,P=0.000),diabetes duration(Z=-2.14,P =0.033),history of hypoglycemia(χ2=5.74,P=0.017),Hb A1c(t=2.76,P =0.006),FBG(t=2.21,P =0.029),ALT(Z=-2.40,P =0.017),AST(Z=-2.24,P =0.025),C-P(0h)(Z=-2.19,P =0.029),C-P(1h)(Z=-2.98,P =0.003),C-P(2h)(Z=-3.21,P =0.001),Ins(1h)(Z=-2.11,P =0.035),Ins(2h)(Z=-2.85,P =0.004),HOMA-β(Z=-2.14,P =0.032),IL-6(Z=-1.98,P =0.048),the above indicators are statistically different between the two groups.Other basic information,thyroid function,Cr,KET,U-ALB/Cr,lipid metabolism indicators,Ins(0h),IL-1β,IL-2R,IL-8,IL-10,TNF-α,HOMA-IR,brain 3.0MRI and ophthalmoscope examinations were not statistically significant.3.Results of MoCA score and gender(r=0.221,P =0.007),years of education(r=0.595,P =0.000),ALT(r=0.211,P =0.010),AST(r=0.233,P =0.004),CP(0h)(r=0.190,P=0.023),C-P(1h)(r=0.210,P=0.012),C-P(2h)(r=0.245,P=0.003),Ins(2h)(r=0.230,P=0.006)were positively correlated.But,age(r=-0.320,P =0.000),diabetes duration(r=-0.271,P =0.001),history of hypoglycemia(r=-0.209,P =0.011),Hb A1c(r=-0.228,P =0.005)were negatively correlated with MoCA score.Moreover,FBG,Ins(1h),HOMA-β,IL-6 were weak or no correlation with MoCA score.4.Years of education was an independent risk factor for T2DM combined with MCI(OR value is 1.250,95% confidence interval is 1.057-3.478).Conclusion:1.The cognitive function of patients with T2DM is worse than that of subjects without diabetes.2.Women with T2DM who are older,have a longer course of diabetes,and have a history of hypoglycemia are more likely to develop MCI.3.T2DM patients with elevated levels of FBG,Hb A1 c and IL-6,and decreased levels of ALT,AST,C peptide,insulin at 1 and 2 hours after a meal,and HOMA-β are more likely to develop MCI.4.Short education time is an independent risk factor for T2DM combined with MCI,suggesting that extending education time and improving education level are beneficial to prevent the occurrence of MCI.