血糖失调与心血管疾病高危老年参与者认知功能恶化有关：PREDIMED-Plus 研究两年随访。
Glycemic Dysregulations Are Associated With Worsening Cognitive Function in Older Participants at High Risk of Cardiovascular Disease: Two-Year Follow-up in the PREDIMED-Plus Study.
机构信息
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain.
Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain.
出版信息
Front Endocrinol (Lausanne). 2021 Oct 29;12:754347. doi: 10.3389/fendo.2021.754347. eCollection 2021.
INTRODUCTION
Type 2 diabetes has been linked to greater cognitive decline, but other glycemic parameters such as prediabetes, diabetes control and treatment, and HOMA-IR and HbA diabetes-related biomarkers have shown inconsistent results. Furthermore, there is limited research assessing these relationships in short-term studies. Thus, we aimed to examine 2-year associations between baseline diabetes/glycemic status and changes in cognitive function in older participants at high risk of cardiovascular disease.
METHODS
We conducted a 2-year prospective cohort study (n=6,874) within the framework of the PREDIMED-Plus study. The participants (with overweight/obesity and metabolic syndrome; mean age 64.9 years; 48.5% women) completed a battery of 8 cognitive tests, and a global cognitive function Z-score (GCF) was estimated. At baseline, participants were categorized by diabetes status (no-diabetes, prediabetes, and <5 or ≥5-year diabetes duration), and also by diabetes control. Furthermore, insulin resistance (HOMA-IR) and glycated hemoglobin (HbA) levels were measured, and antidiabetic medications were recorded. Linear and logistic regression models, adjusted by potential confounders, were fitted to assess associations between glycemic status and changes in cognitive function.
RESULTS
Prediabetes status was unrelated to cognitive decline. However, compared to participants without diabetes, those with ≥5-year diabetes duration had greater reductions in GCF (β=-0.11 (95%CI -0.16;-0.06)], as well as in processing speed and executive function measurements. Inverse associations were observed between baseline HOMA-IR and changes in GCF [β=-0.0094 (95%CI -0.0164;-0.0023)], but also between HbA levels and changes in GCF [β=-0.0085 (95%CI -0.0115, -0.0055)], the Mini-Mental State Examination, and other executive function tests. Poor diabetes control was inversely associated with phonologic fluency. The use of insulin treatment was inversely related to cognitive function as measured by the GCF [β=-0.31 (95%CI -0.44, -0.18)], and other cognitive tests.
CONCLUSIONS
Insulin resistance, diabetes status, longer diabetes duration, poor glycemic control, and insulin treatment were associated with worsening cognitive function changes in the short term in a population at high cardiovascular risk.
CLINICAL TRIAL REGISTRATION
http://www.isrctn.com/ISRCTN89898870, identifier ISRCTN: 89898870.
简介
2 型糖尿病与认知能力下降有关，但其他血糖参数，如糖尿病前期、糖尿病控制和治疗、HOMA-IR 和 HbA 相关糖尿病生物标志物，结果不一致。此外，评估这些关系的短期研究有限。因此，我们旨在研究高心血管疾病风险的老年参与者中，基线糖尿病/血糖状况与 2 年内认知功能变化之间的关系。
方法
我们在 PREDIMED-Plus 研究框架内进行了一项为期 2 年的前瞻性队列研究（n=6874）。参与者（超重/肥胖和代谢综合征；平均年龄 64.9 岁；48.5%为女性）完成了 8 项认知测试，估计了全球认知功能 Z 评分（GCF）。在基线时，根据糖尿病状态（无糖尿病、糖尿病前期和<5 年或≥5 年糖尿病病程）以及糖尿病控制情况对参与者进行分类。此外，测量了胰岛素抵抗（HOMA-IR）和糖化血红蛋白（HbA）水平，并记录了抗糖尿病药物。通过调整潜在混杂因素，拟合线性和逻辑回归模型，以评估血糖状况与认知功能变化之间的关系。
结果
糖尿病前期与认知能力下降无关。然而，与无糖尿病的参与者相比，糖尿病病程≥5 年的参与者的 GCF 降低更大（β=-0.11（95%CI -0.16；-0.06]），以及处理速度和执行功能测量。基线 HOMA-IR 与 GCF 变化呈负相关[β=-0.0094（95%CI -0.0164；-0.0023)]，HbA 水平与 GCF 变化呈负相关[β=-0.0085（95%CI -0.0115，-0.0055)]、简易精神状态检查和其他执行功能测试。糖尿病控制不佳与语音流畅性呈负相关。胰岛素治疗的使用与 GCF[β=-0.31（95%CI -0.44，-0.18)]和其他认知测试所测认知功能的下降呈负相关。
结论
在高心血管风险人群中，胰岛素抵抗、糖尿病状态、较长的糖尿病病程、血糖控制不佳和胰岛素治疗与短期认知功能恶化有关。
临床试验注册
http://www.isrctn.com/ISRCTN89898870，标识符 ISRCTN：89898870。
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