| Objective:To investigate the changes of related hormone levels before and after different degrees of hypoglycemia in elderly patients with type 2 diabetes and their effects on cognitive function.Methods:1.Research object and grouping1.1 Subjects:92 T2DM patients with hypoglycemia during hospitalization were enrolled.1.2 Case grouping:Patients ≥60 years old were divided into elderly group(EDM);Patients aged<60 years were included in the non-elderly group(NEDM).There were 57 patients in EDM group,including 29 males and 28 females,with an average age of(67.211±5.502)years.There were 35 patients in NEDM group,including 15 males and 20 females,with an average age of(50.229±6.752)years.Mild hypoglycemia episodes group(HE1 group)was defined as 3.0mmol/L<blood glucose ≤3.9mmol/L,moderate and severe hypoglycemia episodes group(HE2 group)was defined as blood glucose ≤3.0mmol/L.2.Data collection2.1 Positive sequence collection method:general clinical data,biochemical indexes,and related basic hormone levels were collected from the selected patients:thyroid hormone(FT3,FT4,TSH);Glucagon(GLU);Catecholamin hormones(AD,NAD,DPO);Growth hormone(GH);Cortisol(CORT);Insulin(INS),C-peptide(C-P);RAS system(REN,AII,ALD).Cognitive function was assessed using the Mini-mental State Examination(MMSE)or the Montreal Cognitive Assessment(MoCA)supine position.Blood pressure(SBP,DBP)and heart rate(HR)were monitored immediately when hypoglycemia(blood glucose ≤3.9mmol/L)occurred in enrolled patients.The above hormones,electrocardiogram and cognitive function assessment were re-measured 30 minutes post of correction hypoglycemia.2.2 Inversion collection method:Patients admitted with hypoglycemia(blood glucose ≤3.9mmol/L)and meeting the inclusion criteria of the study cases were monitored for HR,SBP,DBP,post-correction hypoglycemia related stress hormones(the same as above),electrocardiogram and evaluation of cognitive function.After the patient’s blood glucose stabilized,the related basic hormones,electrocardiogram and cognitive function assessment were re-tested.Results:1.General data and biochemical indicators:the previous history of hypoglycemia in EDM group was higher than that in NEDM group(P=0.013);Waise was lower than that in NEDM group(P=0.011).In HE1 group,waist circumference in EDM group was lower than that in NEDM group(P=0.004).Patients with HE1 in the EDM group had higher educational level than those with HE2(P=0.008).The diastolic blood pressure of HE1 patients was higher than that of HE2 patients in EDM group(P=0.013).The diastolic blood pressure of EDM patients in HE1 group was higher than that of NEDM patients(P=0.026).The uric acid in EDM group was higher than that in NEDM group(P=0.014).TC and LDL-C of EDM patients in HE2 group were lower than those of NEDM patients(P=0.016;P=0.028).2.Stress hormones related to baseline and hypoglycemia after correction1)Comparison between EDM and NEDM group:bFT3,bFT4,p30’FT3 and p30’FT4 in EDM group were lower than those in NEDM group,which were(2.772±0.996)pmol/L vs(3.566±1.29)pmol/L,P=0.001;(11.339±5.546)pmol/L vs(14.68±3.81)pmol/L,P=0.001;(3.315±1.045)pmol/Lvs(4.112±1.437)pmol/L,P=0.006;(10.549±5.567)pmol/L vs(13.128±3.846)pmol/L,P=0.010.bBPO and p30’BPO in EDM group were higher than those in NEDM group(60.511±16.177)pg/mL vs(52.595±13.458)pg/mL,P=0.0001;(81.975±51.289)pg/mL vs(53.014±13.628)pg/mL,P=0.0001.p30 ’AD increased significantly in NEDM group compared with EDM group,P=0.001;The increase of p30 ’BPO was lower than that of EDM group(P=0.026).2)Comparison between EDM patients and NEDM patients in HE1 group:bFT3,bFT4,p30’FT3 and p30’FT4 in EDM group were lower than those in NEDM group(2.843±1.039)pmol/L vs 3.832±1.344)pmol/L,P=0.002;(11.402±5.805)pmol/L vs(15.007±3.952)pmol/L,P=0.010;(3.287±1.042)pmol/L vs(4.2±1.61),P=0.019;(10.669±5.646)pmol/L vs(13.79±3.716)pmol/L),P=0.012.bREN and p30’REN in EDM group were lower than those in NEDM group,P<0.05;bAII and p30’AII in EDM group were higher than those in NEDM group,P<0.05,which was statistically significant.3)Comparison between EDM patients and NEDM patients in HE2 group:bDPO,p30’DPO and p30 ’INS values in EDM group were higher than those in NEDM group(64.484±15.814)pg/mL vs(54.779±12.905)pg/mL,P=0.015;(85.408±61.379)pg/mL vs(55.285±13.263)pg/mL,P=0.007;(28.208±36.428)uIU/mL vs(9.77±5.531)uIU/mL,P=0.033.bREN and p30’REN in EDM group were lower than those in NEDM group;bAII and p30 ’All were higher than those in NEDM group,P<0.05,there is statistical significance.p30 ’AD increased significantly in NEDM group compared with EDM group(54.77±41.584)pg/mL vs 13.8± 12.493)pg/mL,P=0.009.3.Cognitive function(bMMSE,p30 ’MMSE’ bMoCA,p30’ MoCA)bMMSE in EDM group was lower than that in NEDM group(26.351±3.568)score vs 28.2±2.495 score,P=0.004.bMMSE and p30 ’MMSE of EDM patients in HE1 group were lower than those of NEDM patients(P=0.020;P=0.022).In HE2 group,the decrease of p30 ’MMSE in NEDM patients was significantly(2.818±2.136)points vs(0.333±3.215)points,P=0.028.In NEDM group,p30 ’MMSE decreased significantly in HE2 patients compared with HEI patients P=0.04.Comparison of bMoCA and p30 ’MoCA among groups,P>0.05,no statistical significance.Conclusion:1.Past history of hypoglycemia,hyperuricemia,and increased diastolic blood pressure;Low educational level,long history of diabetes mellitus and abnormal blood lipids are the risk factors of hypoglycemia in elderly T2DM patients.2.The changes of stress hormones after hypoglycemia correction in the elderly T2DM group were not obvious compared with those in the non-elderly group;Especially when moderate or severe hypoglycemia occurred,the elevated stress hormone level in the elderly group was significantly lower than that in the non-elderly group.3.The basic cognitive function score of elderly T2DM patients was lower than that of non-elderly group,and a single mild or moderate hypoglycemia had no significant effect on cognitive function in the elderly group in a short time.Moderate and severe hypoglycemia can reduce the cognitive function of non-elderly group to a certain extent. |
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