scholarly journals The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin

2020 ◽  
Vol 27 (1) ◽  
pp. 14-27
Author(s):  
Lorenzo Brognara ◽  
Iacopo Volta ◽  
Vito Michele Cassano ◽  
Emmanuel Navarro-Flores ◽  
Omar Cauli
Keyword(s):  
Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Glycemic Control ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Diabetic Foot ◽  
Glycated Hemoglobin ◽  
Diabetic Patients ◽  
Adherence To Treatment

Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician’s recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p < 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p < 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0–73.3% and specificity 70.6–64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level > 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician’s recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.

scholarly journals Asociación del control glucémico con la disfunción eréctil en pacientes diabéticos

2017 ◽  
Vol 77 (1) ◽  
Author(s):  
Juan Figueroa García Juan
Keyword(s):  
Diabetes Mellitus ◽  
Erectile Dysfunction ◽  
Glycemic Control ◽  
Odds Ratio ◽  
Glycated Hemoglobin ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Control Glucémico ◽  
Inadequate Glycemic Control

ANTECEDENTES: la disfunción eréctil es la incapacidad para conseguir y mantener una erección que permita una penetración sexual satisfactoria en 50% de las veces, en un periodo de tres meses. Entre las causas orgánicas, la diabetes mellitus representa 30%. A pesar de esta relación la prevalencia es poco conocida en nuestro medio.OBJETIVO: determinar la asociación entre el control glucémico y la disfunción eréctil en diabéticos.MATERIALES Y MÉTODOS: estudio observacional, transversal y analítico al que se incluyeron pacientes que no refirieron complicaciones al momento del estudio. A todos se les aplicó el cuestionario IIFE-5 (Índice Internacional de la Función Eréctil) para detectar si padecían o no disfunción eréctil, se compararon las concentraciones de hemoglobina glucosilada (HbA1c), y se analizó su asociación mediante la aplicación de la razón de momios.RESULTADOS: en 362 pacientes se encontró una prevalencia de disfunción eréctil de 72.3% (n=272), de estos 80.9% (n=212) estaban en descontrol glucémico, con una razón de momios de 6.92 (IC95%: 4.16 a 11.50).CONCLUSIONES: en los pacientes diabéticos existe una relación 7:1 de probabilidad de disfunción eréctil versus pacientes con adecuado control glucémico.PALABRAS CLAVE: diabetes mellitus, disfunción eréctil, hemoglobina glucosilada, control glucémico.  AbstractBACKGROUND: Erectile dysfunction is the inability to achieve and maintain an erection that enables satisfactory sexual penetration 50% of the time, within a 3-month period. Diabetes mellitus is the organic cause in 30% of cases, but despite this relation, the prevalence of erectile dysfunction is not well known in Mexico.OBJECTIVE: To determine the association between glycemic control and erectile dysfunction in diabetic patients.MATERIALS AND METHODS: An observational, cross-sectional, analytic study included diabetic patients that did not complain of complications at the time of the study. The International Index of Erectile Function (IIEF-5) questionnaire was applied to detect whether or not the patients presented with erectile dysfunction. Their glycated hemoglobin (HbA1c) levels were compared and the association with erectile dysfunction was analyzed through the odds ratio.RESULTS: The prevalence of erectile dysfunction in 362 patients was 72.3% (n=272). Of those patients with erectile dysfunction, 80.9% (n=212) had inadequate glycemic control, with an odds ratio of 6.92 (95% CI: 4.16 to 11.50).CONCLUSIONS: The odds ratio of presenting with erectile dysfunction for diabetic men with inadequate glycemic control and patients with adequate glycemic control was 7:1.KEY WORDS: Diabetes mellitus; Erectile dysfunction; Glycated hemoglobin; Glycemic control

scholarly journals Diabetes mellitus and cognitive impairment

2019 ◽  
Vol 91 (10) ◽  
pp. 112-118
Author(s):  
E V Surkova ◽  
M M Tanashyan ◽  
A I Bespalov ◽  
A V Naminov
Keyword(s):  
Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Functions ◽  
Antidiabetic Drugs ◽  
Cerebrovascular Pathology

The review discusses literature data and the results of our own studies on the effect of diabetes on cognitive functions and cerebrovascular pathology, as well as possible ptogenetic mechanisms for the implementation of this effect. The results of studies on the effects of antidiabetic drugs on cognitive function are presented.

scholarly journals A comparative study for evaluation of cognitive function in type-II diabetes mellitus patients and non-diabetics

2018 ◽  
Vol 7 (4) ◽  
pp. 738
Author(s):  
Dulcie Celia A. ◽  
Ezhil Ramya J. ◽  
Sriviruthi B.
Keyword(s):  
Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
Control Group ◽  
Diabetic Patients ◽  
Type Ii ◽  
Duration Of Diabetes ◽  
The Impact

Background: To evaluate the impact of type-II diabetes mellitus on cognitive function and to assess the factors associated with impaired function.Methods: This prospective study compared 100 type-II diabetic people attending the diabetic clinic of Tirunelveli Medical College Hospital with another 100 membered control group. The study group was selected randomly between the age group of 45-65 years. A neuro-cognitive assessment was done using Standardized Mini Mental State Examination (SMMSE), which is a simple and reliable screening test. This scale has 12 questions with time limits to assess orientation, memory, calculation, language, attention and construction. Magnitude and severity of cognitive decrement were analysed along with the possible factors affecting it.Results: Mean age of the study population was 54.6±7.24 years. Cognitive impairment was noted among 62 of cases and 48 of the control group, which means a 14% higher prevalence of cognitive impairment among the type 2 diabetics. The association of development of cognitive impairment and duration of diabetes mellitus was significant statistically (p value = 0.025443; p<0.05). Other demographic variables like gender, education and domicile were also seen to affect the results.Conclusions: Mild to moderate cognitive impairment was found significantly higher among the type-II diabetics than the non-diabetics. The cognitive impairment was found to be associated with the duration of diabetes. Hence the routine screening of cognition by SMMSE should be done in all type-II diabetic patients.

Abstract 39: GLP-1 Agonists Improve Cerebrovascular Integrity and Vascular Induced Cognitive Impairment and Dementia Beyond Glycemic Control via Restoration of Brain Pericytes Functions in Diabetic Mice

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joseph M Bailey ◽  
Mark Ghaly ◽  
Amy C Barrett ◽  
Sherif Hafez ◽  
Maha M Coucha ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cognitive Impairment ◽  
Glycemic Control ◽  
Cognitive Functions ◽  
Vascular Density ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Diabetic Mice ◽  
Vascular Integrity ◽  
Brain Pericytes

We have previously shown that diabetes causes pericyte-dysfunction that leads to loss of vascular integrity and vascular-induced cognitive impairment and dementia (VCID). Glucagon-like peptide-1(GLP-1), used in the management of type-2 diabetes mellitus, improves cognitive functions in diabetic patients beyond glycemic control, yet the mechanism is unknown. In the present study, we hypothesis that GLP-1 agonist improves VICD through prevention of diabetes-induced pericytes dysfunction in a non-glucose dependent way. Methods: Control and diabetic mice were randomly assigned for saline or Exendin-4 (GLP-1 agonist 30 ng/kg/day), delivered through osmotic pump over 28 days. Vascular integrity was assessed by measuring cerebrovascular neovascularization indices (Vascular density, tortuosity, and branching density). Cognitive functions were evaluated with Barnes maze and Morrison Water maze. Human brain microvascular pericytes, HBMPCs, were grown in high glucose 25 mM/ sodium palmitate 200 uM (HG/Pal) to mimic diabetic conditions. HBMPCs were treated with/out Exendin-4 and assessed for oxidative stress and angiogenic properties. Results: Diabetic mice treated with GLP-1 agonist showed a significant reduction in all cerebral pathological neovascularization indices (P<0.05). Exendin-4 vascular protective effects were accompanied by significant improvement of the learning and memory functions of diabetic mice (P<0.05). Our results showed that HBMPCs expressed the GLP-1 receptor. Treating HBMPCs exposed to diabetic conditions with GLP-1 agonist restored pericyte functions, decreased diabetes-induced inflammation, oxidative stress, and migration (P<0.05). Conclusion: Our results provide novel evidence that GLP-1 agonist produces neurovascular protective effects in part through targeting pericytes. Restoration of pericyte functions in diabetes represents a novel therapeutic target for diabetes-induced vascular remodeling and VCID.

Benzodiazepine & nonbenzodiazepine prescriptions for Taiwanese elderly with type 2 diabetes contributes to cognitive dysfunction

2014 ◽  
Vol 26 (10) ◽  
pp. 1719-1727 ◽  
Author(s):  
Yung-Rung Lai ◽  
Yi-Sun Yang ◽  
Min-Ling Tsai ◽  
Chien-Ning Huang ◽  
Jeng-Yuan Chiou
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Odds Ratio ◽  
National Sample ◽  
Population Based ◽  
Control Group ◽  
Diabetic Patients ◽  
Potentially Inappropriate Medications ◽  
Logistic Analysis

ABSTRACTBackground:This study examined the relationship of cognitive function and benzodiazepine/nonbenzodiazepine hypnotics (BZD/nonBZD) and other risk factors in a national sample of Taiwan's elderly diabetic patients.Methods:Data were drawn from the “2005 Taiwan National Health Interview Survey (NHIS)”, a population-based study of a national sample of adults aged 65 years and older. A total of 653 participants were included in this study. The Mini-Mental State Examination (MMSE) was used to evaluate patient's cognitive function for which the cut-off score is education-adjusted.Results:There were 130 participants left in the diabetic group and 523 participants in the control group. The average age was 74.2 and 73.3 respectively. The rate of cognitive dysfunction in DM and non DM participants was 11.5% (15/130) and 8.4% (44/523). Compared with those without diabetes in multivariate logistic regression, the odds ratio of cognitive impairment was 1.87-fold higher for diabetic patients (95% CI 1.04–3.61) after adjusting for sociodemographic characteristics, comorbidities, and BZD/nonBZD. Other factors were not significant. We performed an additional logistic analysis for which the odds ratio of cognitive impairment in diabetic patients with BZD/nonBZD was significantly increased to 2.41 (95% CI 1.08–5.40) than for patients without diabetes and BZD/nonBZD.Conclusion:In our research, cognitive dysfunction was associated with diabetes. BZD/nonBZD may have conferred additional risk of cognitive impairment in our elderly diabetic patients. We should consider examining the mental function of DM patients regularly and try our best to avoid potentially inappropriate medications (PIMs).

A Different View to Older Diabetics: Management of Treatment According to Cognitive Functions

2019 ◽  
Vol 26 (3) ◽  
pp. 235-241
Author(s):  
Remzi Bahsi ◽  
Deniz Mut Sürmeli ◽  
Tuğba Turgut ◽  
Hande Selvi Oztorun ◽  
Volkan Atmıs ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cognitive Impairment ◽  
Correlation Analysis ◽  
Cognitive Functions ◽  
Insulin Treatment ◽  
Systemic Disease ◽  
Diabetic Patients ◽  
Drug Choice ◽  
Increased Risk

Abstract Background and aims. Diabetes Mellitus is a chronic systemic disease which has multiple complications and the presence of these complications affects the management of disease. It is also important to consider cognitive functions when managing the treatment of older diabetics. In this study, we aimed to make proposals for the appropriate drug choice to preserve cognitive functions in elderly diabetics. Matherial and methods. A total of 270 older diabetic patients were reviewed. Possible risk factors of cognitive impairment were investigated. Correlation analysis was performed between MMSE and GDS, age, HbA1c, duration of diabetes. Results. Sulfonylurea (adj. OR: 2.33, %95 CI: 1.11-4.90) and insulin treatment (adj. OR: 3.79, %95 CI: 1.56-9.21) were found associated with increased risk of cognitive impairment. In addition, there was a negative correlation between MMSE and GDS (r: -.129, p<0.05). Conclusion. We suggest that insulin and sulfonylureas should be used with caution in those with cognitive impairment.

A STUDY TO CORRELATE TOTAL CALCIUM AND GLYCATED HEMOGLOBIN IN TYPE-2 DIABETES PATIENTS.

2021 ◽  
pp. 62-63
Author(s):  
V Indhumathi ◽  
M. Priyatharshini ◽  
P. Muraliswaran ◽  
S Dhanoushyaa
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Glycated Hemoglobin ◽  
Diabetic Patients ◽  
Total Calcium ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Background: The risk for developing diabetic complications are related to glycemic control which is measured by estimating the glycated hemoglobin (HbA1c) level. Calcium increases the GLUT 4 activity. Change in calcium alters the insulin receptor phosphorylation, and decreases the activity of glucose transporter Objective: To nd out the correlation between serum Calcium and glycated Haemoglobin in Type 2 Diabetes Mellitus patients. Materials And Methodology: A cross sectional study which included 100 type 2 Diabetes mellitus patients, divided into 2 groups based on HbA1c levels. Group 1 : Type 2 Diabetic patients with HbA1c more than 7 percent and Group 2 : Type 2 Diabetic patients with HbA1c less than 7 percent. Total calcium level was correlated with glycated hemoglobin level. Statistical analysis was done using unpaired t test. Result: The mean value of serum total calcium was lower in the diabetic group whose HbA1c was > 7 (p value – 0.000) when compared to the diabetic group whose HbA1c was <7. A strong negative correlation (r = -0.391) between calcium and HbA1c in the T2 diabetic patients with HbA1c >7 (p = 0.000) was observed. Conclusion: Alteration in calcium levels will have adverse effects on insulin secretion and release. Estimating the level of calcium becomes important to know the status of insulin in diabetic patients and correlating the levels of HbA1c and Serum Calcium in Type 2 DM patients, can monitor the levels of glycemic control and the risk of development of complications. Calcium supplementation to the diabetic patients can help in better glycemic control and prevent diabetes related complications

scholarly journals Cognitive impairment in patients with diabetes mellitus in the conditions of COVID-19

2021 ◽  
Vol 17 (5) ◽  
pp. 71-75
Author(s):  
N.M. Zherdova
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Cognitive Disorders ◽  
Underlying Disease ◽  
The State ◽  
Patients With Diabetes

This review highlights the state of cognitive functions in patients with metabolic syndrome, diabetes mellitus at the stage of detection of the underlying disease and after COVID-19. The main links in the pathogenesis of cognitive dysfunction in patients with diabetes are explained, and based on previous studies of SARS-CoV-1 and MERS-CoV, possible mechanisms of cognitive impairment in patients infected with COVID-19 are revealed. Methods for the correction of cognitive disorders with the use of modern nootropics, such as phenibut, are proposed.

scholarly journals Evaluation of cognitive functions in diabetic patients

2020 ◽  
Vol 8 (6) ◽  
pp. 2039
Author(s):  
Emre Cakir ◽  
Nazmiye Ozlem Harmankaya ◽  
Hasret Cengiz ◽  
Ceyhun Varim
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Cognitive Status ◽  
Control Group ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
General Internal ◽  
Significant Difference

Background: Diabetes Mellitus is an independent risk factor for cognitive impairment and dementia. In this study, authors investigated cognitive functions in the diabetes and control group with Mini Mental State Examination (MMSE). Authors analyzed the association of cognitive status with age, sex, duration of diabetes, insulin use and HbA1c in diabetic patients.Methods: Fifty patients with diabetes diagnosed between the ages of 50 and 70 who applied to this Diabetes and General Internal Medicine Clinics between January 2017 and September 2017 were included. Fifty patients with nondiabetes diagnosed with similar age and demographic characteristics were included in the control group. MMSE was applied to both groups. In the diabetic group, cognitive functions were investigated in relation with age, gender, duration of diabetes, insulin usage and HbA1c.Results: The MMSE score in diabetic patients was lower than the control group (p<0.05). In addition, cognitive impairment in diabetic patients was associated with duration of diabetes and HbA1c level. There wasn't significant difference was found between cognitive impairment and age, sex, insulin use.Conclusions: Diabetes Mellitus is a risk factor for cognitive impairment and dementia with many possible mechanisms. In the routine, there is no screening for cognitive impairment and dementia in diabetic patients; but if authors detect early cognitive impairment, authors can prevent cognitive impairment progression to dementia with medical treatment and cognitive exercises.

scholarly journals A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

2019 ◽  
Vol 9 (9) ◽  
pp. 98 ◽  
Author(s):  
Kisokanth G. ◽  
Indrakumar J. ◽  
Prathapan S. ◽  
Joseph J. ◽  
Ilankoon I.M.P.S.
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Education ◽  
Self Management ◽  
Rank Test ◽  
Diabetic Patients ◽  
Effective Measure ◽  
Before And After ◽  
Patients With Diabetes ◽  
Preliminary Study

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

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