Effect Of Metabolic Surgery On Cognitive Function Of Type 2 Diabetes Mellitus

Background and ObjectiveDiabetes has become an important risk factor for threatening human life and health.The world has 415 million adult diabetes,is expected to 2040 will be more than 640 million.Type 2 diabetes(T2DM)accounts for 90-95% of diabetic patients,and the cardiovascular and cerebrovascular disease is an important factor affecting its final outcome.Diabetic microangiopathy is one of the common complications of diabetes,studies have shown that chronic hyperglycemia lead to microvascular brain injury.About 70% of diabetic patients with diabetic neuropathy,including central nervous system lesions.It is estimated that 40 million people worldwide suffer from Alzheimer's disease,this figure is expected to double every 20 years to 2050 more than 110 million.The more common types of dement ia are Alzheimer's disease(AD).Cognitive dysfunction is a precursor to Alzheimer's disease.Mild cognitive impairment(MCI)is a cognitive impairment between normal aging and dementia,mainly manifested as memory impairment,especially episode memory defects,but also named obstacles,but the overall cognitive function is normal,daily life ability is normal.Studies have shown that middle-aged diabetic patients' cognitive ability will decline by about 19% in 20 years compared to people without diabetes.Metabolic Surgery was originally used for weight loss purposes,and later it was found that it has reduced the level of blood glucose in diabetic patients,and therefore gradually used to treat diabetes.Metabolic surgery can significantly improve the weight of diabetic patients,blood sugar,blood lipids,blood pressure,and its effect on cognitive function of diabetic patients is still rare.This study was to investigate the metabolic indexes and cognitive function in drug treatment type 2 diabetic patients and the non-diabetic patients and patients with type 2 diabetes mellitus who have accepted the metabolic surgery,and to analyze the changes of cognitive function in patients with type 2 diabetes mellitus,and the comparing effect of metabolic surgery and drug treatment on the cognition function of patients with type 2 diabetes mellitus,and the cognitive function changes before and after the metabolic surgery,to further understand the effect of metabolic surgery on the cognitive function of type 2 diabetes patients,for finding new ways and methods to prevent Alzheimer's disease.Subjects and Methods1.Subjects150 cases are collected from April 2015 to February 2017 in the Daping Hospital affiliated to the Third Military Medical University.They were consisted by non-surgical type 2 diabetes patients,the type 2 diabetes patients who have accepted metabolic surgery and the non-diabetic patients.60 cases were the first part of the study.The changes of cognitive function in type 2 diabetic patients were observed.The remaining 90 cases were the second part of the study.The comparising effects of metabolic surgery and conventional drug therapy on the cognitive function of patients with type 2 diabetes mellitus were observed,and the effect of metabolic surgery to improve the cognitive function of patients with type 2 diabetes mellitus was also observed.Objects of the first part of the study: a total of 60 cases,one group were type 2 diabetes in our hospital or outpatient department in 30 cases,the mean age were 43±8.8 years,including 19 males,the other were non-diabetic patients,the mean age was 42 ± 8.6 years,including 21 males.There were no statistically significant differences in age,gender,and duration of education between the two groups.Objects of the second part of the study: a total of 65 cases,of which non-metabolic surgery in type 2 diabetes patients of 35 cases for drug treatment group,the average age of 45.8 ± 8.5 years,including 22 males;Type 2 diabetes who had have metabolic surgery in 30 cases for the surgical group,the average age of 45 ± 10 years old,including 15 males,the average follow-up time of 1.4 years.There were no statistically significant differences in age,gender,and duration of education between the two groups.Another 25 cases of patients with type 2 diabetes had have metabolic surgery and regular follow-up for six months.The average age was 39 ± 10.1 years,including 11 males.2.Methods and indicatorsAge,gender,education,Height,Waist circumference(WC),blood pressure(BP)of all the objects were recorded,they had have completed the cognitive function of the relevant scale test: including Mini Mental Status Examination(MMSE),Clinical Dementia Rating(CDR),Memory and Execution Screening(MES),Rey Auditory Verbal Learning Test(RAVLT),Trail Making Test(TMT),Digital Span Test(DST),Language Fluency Test(Animal Naming Test,ANT),Visual Space Test(Clock Drawing Test,CDT).Tips: MES includes two parts of memory and execution,RAVLT includes total memory vocabulary(RAVL),delayed memory(LDFR)and retrospective memory(RVL);TMT includes test A(TMT-A)and test B(TMT-B);DST includes forwards(DST-forwards)and backwards(DST-backwards);Total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),hypersensitive C-reactive protein(hs-CRP),fasting glucose(FPG),fasting insulin(FINS)and glycosylated hemoglobin(Hb A1c)of all the objects were detected.Surgical patients completed the above examination at following time.The surgical patient of the study perfected the auditory event-related evoked potential(ERP)EEG information collection in the preoperative and postoperative 6 months.Results1.Changes of cognitive function in patients with type 2 diabetes mellitus1.1 The levels of FPG and Hb A1 c in type 2 diabetes mellitus group were higher than those in non-diabetic control group(P <0.05)and FINS were lower than those in non-diabetic control group(P <0.05).1.2 The cognitive function of patients with type 2 diabetes mellitus was signi ficantly lower than that of the non-diabetic control group(P <0.05).The difference was statistically significant,mainly in the aspects of overall cognitive assessment(MMSE),memory and executive function(MES-T),memory(MES-M),Clinical dementia scale(CDR).2.Effect of metabolic surgery on cognitive function in patients with type 2 diabetes2.1 Comparison of cognitive function in patients with type 2 diabetes mellitus treated with metabolic surgery and conventional drug treatment2.1.1 There were significant differences in BMI,WC,BP,HbA1 C,FPG and TG between the operation group and the drug treatment group(P <0.05).2.1.2 Before the adjustment of two groups`metabolic index,the cognition function of MMSE,CDR,MES(MES-T,MES-M,MES-E),RAVL,LDFR,RVL,ANT,CDT,DST in the operation group was significantly better than those in drug treatment group(P <0.05).After the two groups`metabolic index were corrected,the operation group had significant differences in MES-T,MES-E,RAVL,RVL,ANT,Which was significantly better than that in drug treatment group(P <0.05).2.2.Prospective observation of metabolic surgery to improve the cognitive function of patients with type 2 diabetes mellitus2.2.1 Compared with preoperative cognitive function in patients with type 2 diabetes mellitus,the postoperative cognitive function of MMSE,MES-T,MES-M,RAVL,RVL,ANT,TMT-A,TMT-B,DST-forwards,DST-backwards had improved significantly(P <0.05).2.2.2 The amplitude of P300 in the auditory evoked potentials of patients with type 2 diabetes mellitus was higher than that before operation,and the latency was shorter than that before operation(P <0.05).Conclusion1.Type 2 diabetes may be more prone to mild cognitive impairment,mainly in the overall cognitive evaluation and memory at early stages.2.Metabolic surgery can improve the cognitive function of patients with type 2 diabetes,such as memory,execution,language fluency,attention and orientation and so on.3.Metabolic surgery can significantly improve the EEG P300 wave amplitude and latency which response to cognitive function,the mechanism may be associated with the alteration of brain function benefited from metabolic surgery.