Influencing Factors Of Mild Cognitive Impairment In Elderiy Patients With Type 2 Diabetes

Objective:To explore the relationship between glycosylated hemoglobin(HbA1c)and serum insulin-like growth factor-1(IGF-1)and cognitive dysfunction in type 2 diabetic patients,and further explore the influencing factors of cognitive dysfunction.Methods:156 elderly patients with type 2 diabetes hospitalized in our hospital department of Neurology and Edocrinology in November 2015 to December 2017 were selected as subjects.According to whether there were mild cognitive impairment,they were divided into MCI group and non MCI group,each group including 78 cases.Comparison of patients differences in clinical data and medical history,education level,living habits,blood pressure,HbA1 c,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and IGF-1 level.According to the HbA1 c level,156 patients with type 2 diabetes were divided into 3 groups:A group(HbA1 c < 7%),B group(7%< HbA1 c <7%)and C group(≥8%),each group including 52 cases.MOCA score were compared between the three groups and the influencing factors of patients with cognitive dysfunction were analysised by Spearman correlation and logistic regression.Results:1.The level of education and IGF-1 of MCI group were significantly lower than those of non MCI group,while the levels of HbA1 c,TC,TG and LDL-C were significantly higher than those of non MCI group,the difference was statistically significant(P < 0.05).2.MCI group scored significantly lower in orientation,language,abstraction,delayed recall and visual space execution than those in non MCI group(P < 0.05),but there was no significantly difference between naming and attention in comparison to non MCI groups(P> 0.05).3.Single factor Logistic regression analysis showed that the level of education,HbA1 c and IGF-1 of elderly patients with diabetes was related to cognitive dysfunction(P< 0.05);Multiple factor logistic regression analysis showed that the level of education and IGF-1 were the protective factors of MCI for elderly patients with type 2 diabetes,while the level of HbA1 c was a risk factor of MCI for elderly patients with type 2 diabetes(P <0.05);4.There was negative relationship between the level of education and IGF-1 and MOCA score in elderly patients with type 2 diabetes(P<0.05),while the levels of HbA1 c,TC,TG and LDL-C were significantly positively correlated with MOCA scores in elderly patients with type 2 diabetes(P<0.05).5.There was statistically significant difference between different HbA1 c groups of MOCA scores(P<0.05),the MOCA score of patients with HbA1c≥ 8% was significantly lower than that of patients with HbA1 c <7%(P<0.05);6.The HbA1 c level of elderly patients with type 2 diabetes increased every 1% and MOCA score decreased by 0.11(P<0.05).After adjusting for gender,age and education level,the HbA1 c level increased by 1% and MOCA score decreased by 0.09(P < 0.05).7.For patients with HbA1 C < 7%,HbA1 C increase every 1%,the incidence of MCI in elderly patients with type 2 diabetes i increased by 40%.After adjusting for age and education level,the correlation between them was not statistically significant(P > 0.05);For patients with HbA1 C ≥7%,HbA1 C increases every 1%,the incidence of MCI in elderly patients with type 2 diabetes have increased 55%.After adjusting for age and education,the incidence of MCI in elderly patients with type 2 diabetes still increased by29%(P>0.05).Conclusion:1.The cognitive dysfunction of elderly patients with type 2 diabetes is mainly manifested in orientation,language,abstraction,memory and visual space execution.2.High level of serum lipid and HbA1 c are risk factors for MCI in elderly patients with type 2 diabetes,while high level of education and IGF-1 are protective factors for MCI in elderly patients with type 2 diabetes.3.There was negative relationship between the level of education and IGF-1 and MOCA score in elderly patients with type 2 diabetes(P<0.05),while the levels of HbA1 c,TC,TG and LDL-C were significantly positively correlated with MOCA scores in elderly patients with type 2 diabetes(P<0.05).4.In patients with HbA1c≥7%,HbA1 c increase every 1%,the MOCA scores decrease by 0.09,and the risk of MCI increase by 29%;5.The decrease of serum IGF-1 may contribute to cognitive impairment in elderly patients with type 2 diabetes.