Clinical significance of glycemic variability for prediction of cognitive impairment in elderly patients with metabolic syndrome / 中国医师进修杂志

ABSTRACT

Objective:To investigate the clinical significance and correlation between blood glucose variability and cognitive impairment in elderly patients with metabolic syndrome.Methods:A total of 80 elderly metabolic syndrome patients and 50 healthy controls in Chinese People′s Armed Police Corps Hospital in Sichuan Province from December 2017 to March 2019 were selected as study group and control group respectively, and the difference of general data and biochemical indicators between two groups were compared. The cognitive function of the metabolic syndrome patients was measured by Montreal cognitive assessment scale (MoCA) at admission. The patients were divided into cognitive dysfunction group and normal cognition group according to MoCA score. The glycemic variability was detected by 72-h dynamic monitoring of blood glucose started within 24 h after admission, and the difference of average blood glucose (Glu Ave), standard deviation of glucose (Glu SD), mean amplitude of glycemic excursions in 24 h (MAGE), glycemic index (GLI), glucose variability (Glu CV) and other indicators between cognitive dysfunction group and normal cognition group were also compared. Results:The levels of body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterin (LDL-C), glycated hemoglobin (HbA 1c) were significantly increased in the study group [(25.48 ± 3.86) kg/m 2 vs. (22.83 ± 4.60) kg/m 2, (139.09 ± 10.17) mmHg (1 mmHg = 0.133 kPa) vs. (128.12 ± 7.8) mmHg, (73.00 ± 6.65) mmHg vs. (69.90 ± 5.99) mmHg, (9.12 ± 1.54) mmol/L vs. (4.92 ± 0.63) mmol/L, (2.17 ± 0.49) mmol/L vs. (1.70 ± 0.48) mmol/L, (5.32 ± 0.62) mmol/L vs. (4.61 ± 0.45) mmol/L, (3.05 ± 0.79) mmol/L vs. (2.31 ± 0.53) mmol/L, (7.89 ± 1.92)% vs. (5.30 ± 0.56)%], high density lipoprotein cholesterol (HDL-C) were significantly decreased in the study group [(0.98 ± 0.25) mmol/L vs. (1.19 ± 0.43) mmol/L] compared to the control group, and the differences were statistically significant ( P<0.05). The disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV were markedly increased in the cognitive dysfunction group compared to those in the normal cognition group [(7.39 ± 1.87) years vs. (6.50 ± 1.52) years, (8.52 ± 2.21)% vs. (7.32 ± 1.21)%, (11.6 ± 3.35) mmol/L vs. (9.84 ± 2.19) mmol/L, (2.98 ± 0.54) mmol/L vs. (2.17 ± 0.47) mmol/L, (1.19 ± 0.46) mmol/L vs. (0.71 ± 0.28) mmol/L, 95.83 ± 19.77 vs. 86.94 ± 15.22, (27.96 ± 10.38)% vs. (23.02 ± 8.16)%]( P<0.05). Logistic regression model showed that disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV were independent risk factors for the cognitive impairment in elderly patients with metabolic syndrome.In addition, there were positive correlation between MoCA score and disease course, HbA 1c, Glu Ave, Glu SD, MAGE, GLI, Glu CV ( P<0.05). Receiver operating characteristic curve demonstrated that GluSD>2.56 mmol/L [area under the curve (AUC)=0.897] or (and) MAGE>1.11 mmol/L (AUC = 0.821) may indicated the occurrence of cognitive impairment. Conclusions:Glu Ave, Glu SD, MAGE, GLI and Glu CV are all correlated with cognitive dysfunction in elderly patients with metabolic syndrome, and Glu SD and MAGE may be considered as a potential maker for prediction of cognitive dysfunction.