| Objective In this study,elderly patients with type 2 diabetes mellitus(T2DM)over 60 years old were selected as research objects.Time in range(TIR)was obtained by capillary blood glucose monitoring data to analyze the correlation between TIR and cognitive impairment.Methods From December 2021 to December 2022,A total of 202 elderly patients with T2 DM aged equal or greater than 60 years old who were admitted in the Department of Geriatrics,Lanzhou University Second Hospital were selected as the study subjects,and 70 elderly non-diabetic patients were included as the control group.Montreal Cognitive Assessment(Mo CA)and Mini-mental State Examination(MMSE)were used to evaluate the cognitive function of the selected subjects.The clinical data of the subjects were collected.Including gender,age,duration of T2 DM,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),glycated hemoglobin(Hb A1c),biochemical index,25-hydroxy-vitamin D(25(OH)D),fasting insulin(FINS),2-hour postprandial insulin(2h INS),diabetes complications,history of smoking,history of hypertension,and use of insulin(INS).All fingertip blood glucose data recorded during the course of diabetes in elderly patients with T2 DM were collected.At least 7 point fingertip blood glucose data(before three meals,two hours after meals and before bed)for 3 days within 3 months before admission(monitoring 1 day per month)and 2 days after admission.Time in range(TIR),time above range(TAR),time below range(TBR),standard deviation blood glucose(SDBG),largest amplitude of glycemic excursion(LAGE)and postprandial glucose excursion(PPGE)were calculated and obtained.SPSS25.0 statistical software was used to analyze the above data.P<0.05 was considered statistically significant.Results(1)Basic information: A total of 272 elderly patients were enrolled,including 202 elderly diabetic patients and 70 elderly non-diabetic patients.In elderly diabetic group,the average age was 67.22±6.23 years,87 cases(43.1%)were normal cognitive function,115 cases(56.9%)were cognitive impairment;In the elderly non-diabetic group,the average age was 66.44±5.83 years,with 44 cases(62.9%)with normal cognitive function and 26 cases(37.1%)with cognitive impairment.(2)Comparison of clinical data between elderly diabetic patients and elderly non-diabetic patients: The Mo CA score was 23.5±4.53 and MMSE score was24.93±3.93 in the elderly diabetic group.The Mo CA score was 25.35±2.63 and MMSE score was 26.37±2.05 in the elderly non-diabetic group(P<0.05).The prevalence of cognitive impairment in the elderly diabetic group is higher than that in the elderly non-diabetic group.There were significant differences in the prevalence of hypertension,BMI,SBP,Urea(BUN),high density lipoprotein(HDL),low density lipoprotein(LDL)between the two groups(P<0.05).(3)Comparison of clinical data and blood glucose variability between elderly diabetic patients with normal cognitive function and those with cognitive impairment:The age,prevalence of hypertension,Hb A1 c,SBP,FPG,2h PG,BUN,prevalence of DN,prevalence of DR,and use of INS in the cognitive impairment group were higher than those in the normal cognitive function group,while the education level,25(OH)D,Mo CA score,and MMSE score were lower than those in the normal cognitive function group(P<0.05).Comparison of blood glucose fluctuation indexes between the two groups: TIR in the group with cognitive impairment was lower than that in the group with normal cognitive function(P<0.05),while TAR,TBR,SDBG,LAGE and PPGE in the group with cognitive impairment were higher than that in the group with normal cognitive function(P<0.05).(4)Spearman correlation analysis of Mo CA,MMSE score and various indexes in elderly diabetic patients: Mo CA and MMSE scores were positively correlated with education level,25(OH)D and TIR(P<0.05),and negatively correlated with age,SBP,Hb A1 c,BUN,TAR,SDBG,LAGE and PPGE(P<0.05).(5)Comparison of clinical data of elderly diabetic patients with different TIR levels: according to the TIR quartile level,they were divided into TIR≤42% group(47cases),43%-58% group(52 cases),59%-77% group(53 cases),and >77% group(50cases).It was found that with the increase of TIR,MMSE score,Mo CA score and education level showed an increasing trend(P<0.05).The prevalence of cognitive impairment,age,course of T2 DM,Hb A1 c,FPG,2h PG,prevalence of DN and DR,use of INS,TAR,SDBG,LAGE and PPGE were decreased(P<0.05).Spearman correlation analysis found that TIR grade was positively correlated with Mo CA and MMSE scores(P<0.05),and negatively correlated with the prevalence of cognitive impairment(P<0.05).(6)Comparison of cognitive function between TIR standard group and TIR non-standard group in elderly diabetic patients: According to TIR>50% or not,patients were divided into two groups: standard group with TIR>50%(122 cases)and non-standard group with TIR≤50%(80 cases).Compared with the non-standard group,the Mo CA and MMSE scores of the standard group were higher(P<0.05),and the prevalence of cognitive impairment was lower(P<0.05).Logistic regression analysis showed that TIR>50% was an independent protective factor for cognitive impairment after stepwise adjustment for confounding factors(P<0.05).(7)Analysis of influencing factors of cognitive impairment in elderly diabetic patients: TIR,education level and 25(OH)D were independent protective factors for cognitive impairment in elderly T2 DM patients(P<0.05),TAR and age were independent risk factors for cognitive impairment in elderly T2 DM patients(P<0.05).(8)Linear regression analysis of TIR and MOCA,MMSE scales: TIR was positively correlated with MOCA score and MMSE score(P<0.05).For every 10%increase in TIR,MOCA score increased by 0.34 point and MMSE score increased by0.35 point.(9)Comparison of TIR and cognitive function in elderly diabetic patients with different age and disease course groups: According to age and course of disease,the patients were divided into 60-64 years old group(82 cases),64-69 years old group(56cases),≥70 years old group(64 cases),T2 DM course <10 years group(104 cases),T2 DM course ≥10 years group(98 cases).After adjusting for confounding factors,binary Logistic regression analysis showed that TIR was negatively correlated with cognitive impairment regardless of age and disease duration(P<0.05).Conclusion(1)Compared with non-diabetic elderly patients,elderly patients with T2 DM have lower cognitive function scores and higher prevalence of cognitive impairment.(2)There is a significant correlation between TIR and cognitive impairment in elderly patients with T2 DM.(3)Standard TIR was an independent protective factor for cognitive impairment in elderly patients with diabetes.With the increase of TIR,the cognitive function scores of elderly T2 DM patients showed an upward trend.Control of TIR can delay the occurrence of cognitive impairment. |
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