Service of geriatric medicine and geriatric rehabilitation, University of Lausanne Medical Center (CHUV), Route de Mont Paisible 16, Lausanne, 1011, Switzerland.
Service of geriatric medicine, Hospital of Valais, Avenue de la Fusion 27, Martigny, 1920, Switzerland.
BMC Geriatr. 2024 May 14;24(1):427. doi: 10.1186/s12877-024-05025-x.
Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes.
Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated.
Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj β coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj βcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj βcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj βcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj βcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj βcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036).
A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.
在患有神经认知障碍的老年人中，常采用严格的糖尿病控制方法，这导致低血糖发作的频率增加，但对于这些过度治疗的患者的脑损伤模式知之甚少。本研究旨在：(a) 在一个学术记忆诊所中随访的临床人群中，量化认知障碍的老年患者中糖尿病过度治疗的患病率；(b) 确定导致过度治疗的危险因素；(c) 探讨糖尿病过度治疗与特定脑区体积变化之间的关系。
对 2013 年至 2020 年在记忆诊所诊断为 2 型糖尿病和认知障碍的老年患者进行回顾性研究。根据患者的健康状况，将患者分为脆弱型和依赖型。当脆弱型患者的糖化血红蛋白（HbA1c）低于 7%，依赖型患者的 HbA1c 低于 7.6%时，定义为过度治疗。在多变量分析中，研究了与过度治疗相关的特征。使用基于体素的形态测量法从 MRI 测量定义脑区的灰质体积，并比较过度治疗和适当治疗患者的体积。
在纳入的 161 名患者中（中位年龄 76.8 岁，范围 60.8-93.3 岁，32.9%为女性），29.8%被认为是适当治疗，54.0%为过度治疗，16.2%为治疗不足。在多变量分析中，糖尿病过度治疗与年龄或认知障碍的严重程度之间没有关联。在有神经影像学数据的患者中（N=71），过度治疗与灰质丢失之间存在关联。具体而言，在尾状核（校正β系数：-0.217，95%置信区间：[-0.416 至-0.018]，p=0.033）、中央前回（校正β系数：-0.277，95%置信区间：[-0.482 至-0.073]，p=0.009）、额上回（校正β系数：-0.244，95%置信区间：[-0.458 至-0.030]，p=0.026）、距状裂皮质（校正β系数：-0.193，95%置信区间：[-0.386 至-0.001]，p=0.049）、顶上回（校正β系数：-0.291，95%置信区间：[-0.521 至-0.061]，p=0.014）和枕下回（校正β系数：-0.236，95%置信区间：[-0.456 至-0.015]，p=0.036）中观察到灰质体积显著减少。
相当一部分患有糖尿病和神经认知障碍的老年患者接受了过度强化的治疗。与几个特定脑区体积减少相关的关联突出表明，需要在更大的样本中进一步研究过度治疗和相关低血糖症与潜在脑损伤之间的关系。
