Cognitive Disorders, Depressive Status and Chronic Complications of Type 2 Diabetes Mellitus

AbstractBackground and aims: Depression and cognitive disorders were reported more frequently in patients with diabetes mellitus (DM). Our aim was to analyze the association of cognitive disorders and depression association with chronic complications of DM in a group of Romanian patients. Materials and methods: The data was analyzed from 181 patients, with a mean age of 58,3 years to whom we applied the MMSE (Mini- Mental State Examination) and MADRS (Montgomery-Asberg Depression Rating Scale) questionnaires. We also analyzed the presence of chronic DM complications, HbA1c and lipid profile. Results: Most patients with type 2 diabetes mellitus (T2DM) had mild cognitive impairment (92%), more common in the age group 50-59 years. Chronic macrovascular complications were present in 74.58%, while chronic microvascular complications were present in 61.87% of patients with T2DM who associated mild and moderate cognitive impairment (p = 0.013). The most common form of depression was mild depression (90.2%), present in most patients with DM, regardless of progression and type of treatment. MADRS depression test scores were statistically significant correlated with the presence of peripheral artery disease - PAD (p <0.001), ischemic heart disease - IHD (p <0.001) and chronic kidney disease - CKD (p =0.05). We did not find a statistically significant correlation with HbA1c and serum lipid values (p˃0,05). Conclusion: Chronic diabetes macrovascular complications (PAD, IHD) and CKD were more frequently associated with cognitive disorders and depression in patients with T2DM independent of the degree of metabolic control.

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Hamilton rating scale for depression-24 (HAM-D24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients

Psychiatry Research ◽

10.1016/j.psychres.2017.07.050 ◽

2017 ◽

Vol 258 ◽

pp. 177-183 ◽

Cited By ~ 7

Author(s):

Shuo Pan ◽

Zhong-Wei Liu ◽

Shuang Shi ◽

Xun Ma ◽

Wen-Qian Song ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Rating Scale ◽

Microvascular Complications ◽

Diabetic Microvascular Complications ◽

Hamilton Rating Scale

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C-peptide and the risk for incident complications and mortality in type 2 diabetic patients: a retrospective cohort study after a 14-year follow-up

Acta Endocrinologica ◽

10.1530/eje-12-0085 ◽

2012 ◽

Vol 167 (2) ◽

pp. 173-180 ◽

Cited By ~ 41

Author(s):

S Bo ◽

L Gentile ◽

A Castiglione ◽

V Prandi ◽

S Canil ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Retrospective Cohort ◽

Microvascular Complications ◽

Chronic Complications ◽

C Peptide ◽

All Cause Mortality

ObjectiveC-peptide, a cleavage product of insulin, exerts biological effects in patients with type 1 diabetes mellitus, but its role in type 2 diabetes mellitus is controversial. Our aim was to examine the associations between fasting C-peptide levels and all-cause mortality, specific-cause mortality and the incidence of chronic complications in patients with type 2 diabetes.DesignRetrospective cohort study with a median follow-up of 14 years.MethodsA representative cohort of 2113 patients with type 2 diabetes mellitus and a subgroup of 931 individuals from this cohort without chronic complications at baseline from a diabetic clinic were studied.ResultsPatients with higher C-peptide levels had higher baseline BMI and triglyceride and lower HDL-cholesterol values. During the follow-up, 46.1% of the patients died. In a Cox proportional hazard model, after multiple adjustments, no significant association was found between the C-peptide tertiles and all-cause mortality or mortality due to cancer, diabetes or cardiovascular diseases. In the subgroup of 931 patients without chronic complications at baseline, the incidence of microvascular complications decreased from the first to the third C-peptide level tertile, while the incidence of cardiovascular disease did not differ. The risks for incident retinopathy (hazard ratio (HR)=0.33; 95% confidence interval (CI) 0.23–0.47), nephropathy (HR=0.27; 95% CI 0.18–0.38) and neuropathy (HR=0.39; 95% CI 0.25–0.61) were negatively associated with the highest C-peptide tertile, after adjusting for multiple confounders.ConclusionsHigher baseline C-peptide levels were associated with a reduced risk of incident microvascular complications but imparted no survival benefit to patients with type 2 diabetes mellitus.

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An Association of Fasting C-Peptide Levels and Vascular Complications in Chronic Type 2 Diabetes Mellitus Patients

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47265.14506 ◽

2021 ◽

Author(s):

T Thippeswamy ◽

Nirmal Nithin ◽

Prathima Chikkegowda

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Microvascular Complications ◽

Vascular Complications ◽

Protective Role ◽

Macrovascular Complications ◽

C Peptide ◽

Peptide Level

Introduction: Numerous biochemical markers are being used in clinical practice for the prediction and prognostication of vascular complications among non diabetic individuals. Of late, fasting C-peptide levels is being investigated for its possible role in the prediction and protection of vascular complications of diabetes. It is also being explored for its protective role in prevention of vascular complications among patients with diabetes mellitus. Aim: The present study was undertaken with an objective to assess the strength of association of fasting C-peptide levels in the development of microvascular and macrovascular complications. Materials and Methods: An observational cross-sectional study involving 100 subjects with Type 2 Diabetes mellitus (T2DM) having an objective evidence of vascular complications were included into the study. The study period was 18 months from October 2017 to September 2019. After an overnight fasting of atleast 12 hours, C-peptide level estimation was done by Electro-Chemiluminescence Assay (ECLA) method. Results: The overall mean fasting C-peptide level among subjects with microvascular complications (0.73±0.55 ng/mL) was significantly decreased compared with subjects having macrovascular complications (2.44±0.72 ng/mL, with p-value being <0.001). Among microvascular complications, the mean fasting C-peptide level was least in subjects with diabetic retinopathy (0.64±0.35 ng/mL). Among patients with macrovascular complications, preserved C-peptide levels were observed in subjects with ischemic heart disease (2.35±0.75 ng/mL). Conclusion: Fasting serum C-peptide levels are significantly reduced among subjects with chronic T2DM having microvascular complications when compared to macrovascular complications. Also, with preserved serum levels, fasting C-peptide might have a protective role in the prevention of macrovascular complications among subjects with diabetes mellitus.

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Features of Pathogenesis and Course of Type 2 Diabetes Mellitus and Comorbid with it Cardiovascular Pathology in Elderly Patients

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.03.022 ◽

2021 ◽

Vol 6 (3) ◽

pp. 22-36

Author(s):

Yu. G. Gorb ◽

◽

V. I. Strona ◽

O. V. Tkachenko ◽

S. A. Serik ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cognitive Impairment ◽

Chronic Heart Failure ◽

Elderly Patients ◽

Microvascular Complications ◽

The Body

The features of the pathogenesis and course of type 2 diabetes mellitus and diseases of the cardiovascular system comorbid with it are considered in patients of elderly and old age – coronary artery disease, arterial hypertension, chronic heart failure. The leading role of insulin resistance, hyperglycemia and dyslipidemia in the development of metabolic, homeostatic disorders, the formation of oxidative stress and endothelial dysfunction, which, together with age-related changes in the body, contribute to the progression of type 2 diabetes mellitus and microvascular complications, primarily diabetic cardiomyopathy. Particular attention is paid to the relationship between cognitive impairment, type 2 diabetes mellitus and chronic heart failure. The main factors that worsen the course and prognosis of type 2 diabetes mellitus in elderly patients, in particular, hypertension, atrial fibrillation, diabetic polyneuropathy, nephropathy, and other concomitant diseases, have been identified. Lack of compensation for type 2 diabetes due to metabolic disorders leads to the development of diabetic cardiovascular autonomic neuropathy, diabetic cardiomyopathy along with the progression of atherosclerotic lesions of different localization. The course of type 2 diabetes in these patients is often complicated by geriatric syndrome, which contains a set of cognitive impairment, senile weakness, depression, functional disorders, polymorbidity. Cognitive disorders negatively affect the course of type 2 diabetes and its complications, significantly disrupting the process of teaching patients the methods of self-control, following the advice of a doctor. It is noted that the management of this category of patients should be individual and include adequate correction of hyperglycemia to prevent microvascular complications and hypoglycemic conditions, as well as reduce cardiovascular mortality and maintain quality of life. Rational selection of drugs, taking into account the factors that determine their impact on the body of elderly patients with type 2 diabetes mellitus and possible adverse drug reactions, will increase the effectiveness and safety of drug therapy in such patients. Optimizing therapeutic approaches for elderly patients with type 2 diabetes requires effective changes in the health care system to provide them with comprehensive medical and social care according to their special needs

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CORRELATIONS BETWEEN THE SEVERITY OF CARDIOVASCULAR AUTONOMIC NEUROPATHY AND OTHER COMPLICATIONS IN TYPE 2 DIABETES MELLITUS

Romanian Journal of Neurology ◽

10.37897/rjn.2016.1.2 ◽

2016 ◽

Vol 15 (1) ◽

pp. 16-23

Author(s):

Anca Motataianu ◽

◽

Zoltan Bajko ◽

Smaranda Maier ◽

Adina Stoian ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Autonomic Neuropathy ◽

Microvascular Complications ◽

Macrovascular Complications ◽

Cardiovascular Autonomic Neuropathy ◽

Peripheral Vascular ◽

Number Of Patients

Introduction. Cardiovascular Autonomic Neuropathy (CAN), also known as the “silent killer”, represents a serious complication of diabetes mellitus and is most of the times ignored. This is a highly topical issue, given the increased number of patients diagnosed with type 2 diabetes mellitus (T2DM). The purpose of this study was to determine the association between the severity of CAN and the severity of other microvascular complications, such as diabetic sensory-motor polyneuropathy (DSMP), diabetic retinopathy (DR) and macrovascular complications (carotid and peripheral vascular atherosclerosis) in patients with T2DM. Methods. A total of 149 patients with T2DM were assessed for CAN using the Ewing’s battery of cardiovascular autonomic function tests. The patients were evaluated for diabetic microvascular complications (DSMP, RD), respectively macrovascular complications (carotid atherosclerosis by intima media thickness and peripheral vascular atherosclerosis by ankle-brachial index). Results. Of the 45 patients with intermediate CAN, 35.55% were without DR, 51.11% had non-proliferative DR and 13.33% had proliferative DR. From the 13 patients with severe CAN, 76.92% had non-proliferative DR and 23.07% had proliferative DR. From the 56 patients with subclinical CAN, 26.7% had no DSMP, 48.2% had subclinical DSMP and 25% had clinical DSMP. Of the 45 patients with intermediate CAN, 11.2% had subclinical DSMP and 80% had clinical DSMP. Conclusion. In T2DM we demonstrated that an increase in the severity of cardiovascular autonomic injury is associated with an increase in the prevalence and severity of DSMP and DR, respectively carotid and peripheral atherosclerosis.

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