Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1019-1030
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1019
Relationship between glycemic variability and cognitive function in lacune patients with type 2 diabetes
Qi-Zhe Meng, Yang Wang, Bing Li, Zhi Xi, Ming Wang, Jia-Qi Xiu, Xiao-Peng Yang
Qi-Zhe Meng, Yang Wang, Bing Li, Zhi Xi, Ming Wang, Jia-Qi Xiu, Xiao-Peng Yang, Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
Author contributions: Meng QZ proposed the overall research goal and designed the research plan and model design; Yang XP conducted feasibility analysis, review and supervision of the experiment; Wang M, Li B, and Xiu JQ collected clinical data; Meng QZ and Wang Y conducted statistical processing and analysis of the data; Meng QZ and Xi Z are responsible for writing the first draft of the paper; Yang XP is responsible for the review, revision and quality control of the paper; all authors determined the final draft of the paper.
Supported by the Medical Technology and Science Research Project in Henan Province, China, No. SBGJ202102177.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Zhengzhou University (2022031).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Peng Yang, Doctor, Chief Doctor, Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Jingba Road, Jinshui District, Zhengzhou 450003, Henan Province, China. yaxipe39@126.com
Received: November 7, 2022
Peer-review started: November 7, 2022
First decision: December 20, 2022
Revised: December 26, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: February 16, 2023
Processing time: 99 Days and 5.8 Hours
Abstract
BACKGROUND

Lacunes are the manifestations of lacunar infarction which can lead many patients to the clinical outcome of disability or dementia. However, the relationship between lacune burden, cognitive function and blood glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) complicated with lacunes is not very clear.

AIM

To explore the correlation between glucose variability, lacune burden and cognitive function in patients with lacunes complicated with T2DM.

METHODS

The clinical and imaging data of 144 patients with lacunes combined with T2DM were reviewed retrospectively. 72 h continuous glucose monitoring was performed. The Montreal Cognitive Assessment was used to assess cognitive function. The burden of lacunes was evaluated using magnetic resonance imaging performance. Multifactorial logistic regression analysis was used to study the affecting the lacune load and cognitive impairment in patients. To predict the value of patients' cognitive impairment with lacunes complicated with T2DM, a receiver operating characteristic (ROC) curve and a nomogram prediction model were constructed.

RESULTS

The standard deviation (SD) of the average blood glucose concentration, percentage coefficient of variation (%CV) and time of range (TIR) were significantly different between the low and the high load groups (P < 0.05). The SD, %CV and TIR of the cognitive impairment group and non-cognitive impairment group were significantly different (P < 0.05). SD (odds ratio (OR): 3.558, 95% confidence interval (CI): 1.268-9.978, P = 0.006), and %CV (OR: 1.192, 95%CI: 1.081-1.315, P < 0.05) were the risk factors for an increased infarct burden in lacunes patients complicated with T2DM. TIR (OR: 0.874, 95%CI: 0.833-0.928, P < 0.05) is a protective factor. In addition, an increased SD (OR: 2.506, 95%CI: 1.008-6.23, P = 0.003), %CV (OR: 1.163, 95%CI: 1.065-1.270, P < 0.05) were the risk factors for cognitive impairment in patients with lacunes complicated with T2DM, TIR (OR: 0.957, 95%CI: 0.922-0.994, P < 0.05) is a protective factor. A nomogram prediction model of the risk of cognitive impairment was established based on SD, %CV and TIR. Decision curve analysis and the internal calibration analysis were used for internal verification and showed that the model was clinical benefit. The area under the ROC curves for predicting cognitive impairment in patients with lacunes complicated with T2DM was drawn were %CV: 0.757 (95%CI :0.669-0.845, P < 0.05), TIR: 0.711 (95%CI: 0.623-0.799, P < 0.05).

CONCLUSION

Blood glucose variability is closely associated with the level of lacune burden and cognitive dysfunction in lacune patients combined with T2DM. %CV, TIR have a certain predictive effect in cognitive impairment in lacune patients.

Keywords: Blood glucose variability; Lacunes; Type 2 diabetes; Cognitive impairment; Nomograms

Core Tip: Standard deviation, percentage of coefficient of variation, largest amplitude of glucose, and time of range were used in this study describe the degree of glucose variability (GV) more comprehensively and effectively in patients. Statistical analysis confirmed the close relationship between GV, lacune burden and cognitive function in lacune patients with type 2 diabetes mellitus (T2DM). In addition, a nomogram prediction model of GV index and lacunes complicated with T2DM patients with cognitive impairment was established, which could concisely and intuitively reflect the relationship between the risk of cognitive impairment in lacune patients complicated with T2DM and various risk factors.