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Category: Volume 06 Issue 07 July 2018
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Title: Cognitive decline in newly diagnosed Type 2 Diabetes and the effect of good glycemic control on cognitive function

Authors: Sunil Prasobh P, Monisha H

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.05

Abstract

Background: Diabetes is a complex metabolic disease with devastating effects on multiple organ systems, including the brain. The latter complication is often referred to as "diabetic encephalopathy" and is characterized by mild to moderate impairments in cognitive function , associated with an increased risk of dementia .The aim of our study was to characterize the clinical profile of patients newly diagnosed with Type2 Diabetes (within six months of onset) and to assess the dementia score of these patients by MMSE(Mini Mental state examination) at  presentation and to find out the prevalence of cognitive impairment in this population. Also an attempt was made to study the relation of glycemic control with the dementia scores. These patients were also followed up at one year to assess their MMSE scores.

Materials and Methods: 140 patients, newly detected with Type2 Diabetes (within six months of onset) were enrolled in the study. Clinical details were obtained with a structured proforma. MMSE scores of the patients were measured at baseline and after one year. The baseline MMSE score was compared with the clinical profile of these patients.

Results: The mean age of the cases were 56.5 years with slightly higher male predilection (M:F=1.41:1). On detailed evaluation hypertension was seen in 55%, Coronary artery disease in 35.7%, dyslipidemia in 36.4% , alcoholism in 44.1%, and smoking in 45% of cases. There were also microvascular complications like Diabetic Nephropathy in 17.1%, Diabetic Retinopathy in 10.7% of cases.  Most of the cases had poor metabolic control with 75.7% having FBS of >130, 68.6% having PPBS >180 and 78.6% having HbA1c >7. The mean MMSE score at baseline were 24.1 and at one year were 24.6.  There was statistically significant difference in dementia scores as assessed by MMSE at baseline and one year in our cases (p<0.001).The prevalence of cognitive dysfunction as assessed by MMSE was 30%. There was a statistically significant fall in MMSE with presence of Diabetic Nephropathy (MMSE p=0.002) and Diabetic Retinopathy (MMSE p=0.004). Poor glycemic control was linked statistically to a low MMSE score. For lower MMSE score there was a statistically significant increase in the PPBS values (MMSE,p=0.013) and HbA1c levels (MMSE score,p=0.002). 

Conclusion: A significant proportion (30%) of newly diagnosed Type2 Diabetes (within 6 months) patients had impairment of cognitive function. Cognitive dysfunction in patients with Type2 Diabetes was directly related to poor glycemic status. Among the glycemic targets, Post prandial blood glucose values and HbA1C had better correlation with cognitive decline than Fasting plasma glucose levels. Presence of  microvascular complications of Type2 Diabetes such as Nephropathy and Retinopathy predicted cognitive decline. No definite association was seen between cognitive dysfunction and macrovascular disease especially Coronary artery disease in newly diagnosed Type 2 Diabetes. Cognitive dysfunction was independent of other vascular risk factors such as Hypertension, Dyslipidemia and Smoking.  Adequate glycemic control in early stages of Type 2 Diabetes may result in improvement in cognitive function.

Keywords: Type2 Diabetics, MMSE, Cognitive decline, Glycemic control.

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Corresponding Author

Dr Sunil Prasobh P

Department of Internal Medicine, Government Medical College Thiruvananthapuram-695011, Kerala, India

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