PDF(Pubmed)
Abstract：
BACKGROUND: Adherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40-74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country.
METHODS: A case-control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson\'s r.
RESULTS: The primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0-0.26). In linear regression analysis among MoCA-B and IADL scores, \"delayed recall\" and \"orientation\" domains from MoCA-B, and \"managing medications\" and \"using the phone\" from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B\'s \"orientation\" with IADL\'s \"using the phone\" and \"managing medications\" (p-values < 0.0001).
CONCLUSIONS: Superior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients\' instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.
METHODS: A case-control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson\'s r.
RESULTS: The primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0-0.26). In linear regression analysis among MoCA-B and IADL scores, \"delayed recall\" and \"orientation\" domains from MoCA-B, and \"managing medications\" and \"using the phone\" from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B\'s \"orientation\" with IADL\'s \"using the phone\" and \"managing medications\" (p-values < 0.0001).
CONCLUSIONS: Superior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients\' instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.
摘要：
背景：在2型糖尿病治疗中，从口服药物到胰岛素注射的过渡的坚持在患者中有所不同，并且并非一致成功，在某些情况下导致血糖控制欠佳。这项研究旨在探讨中老年人（40-74岁）诊断为2型糖尿病不到10年的认知和日常功能能力与血糖控制之间的潜在相关性。特别是那些最近过渡到胰岛素注射的人，在发展中国家的背景下，他们的教育水平较低。
方法：进行了一项病例对照研究，其中30例HbA1c水平>8％控制不佳的糖尿病（PCDM）患者与30例HbA1c水平≤8％的糖尿病（FCDM）患者进行比较。作为两组暴露量的基础蒙特利尔认知评估(MoCA-B)评分小于27分。此外,使用Pearson的r.
结果：主要结局显示两个糖尿病组的MoCA-B评分之间无粗差异(p值=0.82)。然而,在调整了年龄之后，教育,和IADL得分，在IADL评分较高的受教育程度较低的年轻老年人中,认知功能下降显示了对PCDM的意外保护作用(p值<0.0001,OR95%CI=0~0.26).在MoCA-B和IADL评分之间的线性回归分析中，来自MoCA-B的“延迟召回”和“定向”域，来自IADL的“管理药物”和“使用电话”与HbA1c水平呈负相关（p值分别为<0.01、0.043、0.015和0.023）。电池内和电池间的相关性进一步说明了MoCA-B的“方向”与IADL的“使用电话”和“管理药物”之间的强关联（p值<0.0001）。
结论：在某些认知领域的出色表现与更好的血糖控制有关。尽管如此，因为在临床常规中评估认知领域可能是及时的，通过评估患者使用手机或管理药物的器械能力，可以采取一种潜在的快速方法。需要未来的研究包括更大的样本量和更广泛的社会心理因素来阐述我们的发现。
方法：进行了一项病例对照研究，其中30例HbA1c水平>8％控制不佳的糖尿病（PCDM）患者与30例HbA1c水平≤8％的糖尿病（FCDM）患者进行比较。作为两组暴露量的基础蒙特利尔认知评估(MoCA-B)评分小于27分。此外,使用Pearson的r.
结果：主要结局显示两个糖尿病组的MoCA-B评分之间无粗差异(p值=0.82)。然而,在调整了年龄之后，教育,和IADL得分，在IADL评分较高的受教育程度较低的年轻老年人中,认知功能下降显示了对PCDM的意外保护作用(p值<0.0001,OR95%CI=0~0.26).在MoCA-B和IADL评分之间的线性回归分析中，来自MoCA-B的“延迟召回”和“定向”域，来自IADL的“管理药物”和“使用电话”与HbA1c水平呈负相关（p值分别为<0.01、0.043、0.015和0.023）。电池内和电池间的相关性进一步说明了MoCA-B的“方向”与IADL的“使用电话”和“管理药物”之间的强关联（p值<0.0001）。
结论：在某些认知领域的出色表现与更好的血糖控制有关。尽管如此，因为在临床常规中评估认知领域可能是及时的，通过评估患者使用手机或管理药物的器械能力，可以采取一种潜在的快速方法。需要未来的研究包括更大的样本量和更广泛的社会心理因素来阐述我们的发现。
