Thabit Hood, Kyaw Tun Tommy, McDermott John, Sreenan Seamus
Dept. of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
Curr Diabetes Rev. 2012 Mar;8(2):109-15. doi: 10.2174/157339912799424555.
Diabetes mellitus (DM) is a chronic medical condition that is dependent upon patients self-caring and managing their condition to achieve optimal control. Adherence to medical therapy, making decisions related to lifestyle changes, and self-treating hypoglycaemia for example, require planning and organisational skills that are under the control of a specific domain of cognitive function known as executive function. Executive function has been shown by functional imaging studies such as magnetic resonance imaging to be under the influence of the frontal and prefrontal cortical system. It is now recognised that even in subjects with apparently normal cognition, DM may be associated with impaired executive function (IEF). The exact cause of IEF in DM is still not fully understood. However cerebral microvascular disease and chronic dysglycaemia have been postulated as possible factors contributing to functional neuronal dysfunction leading to IEF. IEF may adversely affect patients' abilities to self-manage their diabetes care, potentially cause worsening glycaemic control and difficulty managing risk factors. Several bedside assessment tools to screen for IEF are currently available and have been shown to correlate with functional status. However, more studies are needed to validate these tests against diabetes self-care assessment tools. Until then, clinicians and healthcare workers managing patients with DM should be aware of the potential for IEF in their patients as specific behaviour and education intervention may be needed to help manage patients with diabetes and IEF.
糖尿病（DM）是一种慢性疾病，患者需要自我护理和管理病情以实现最佳控制。例如，坚持药物治疗、做出与生活方式改变相关的决策以及自我治疗低血糖，都需要规划和组织能力，而这些能力受认知功能的一个特定领域即执行功能的控制。功能成像研究如磁共振成像表明，执行功能受额叶和前额叶皮质系统的影响。现在人们认识到，即使在认知明显正常的受试者中，糖尿病也可能与执行功能受损（IEF）有关。糖尿病中IEF的确切原因仍未完全了解。然而，脑微血管疾病和慢性血糖异常被认为是导致功能神经元功能障碍进而引起IEF的可能因素。IEF可能会对患者自我管理糖尿病护理的能力产生不利影响，可能导致血糖控制恶化以及难以管理危险因素。目前有几种用于筛查IEF的床边评估工具，并且已证明它们与功能状态相关。然而，需要更多研究来对照糖尿病自我护理评估工具验证这些测试。在此之前，治疗糖尿病患者的临床医生和医护人员应意识到患者存在IEF的可能性，因为可能需要特定的行为和教育干预来帮助管理患有糖尿病和IEF的患者。
