Background. Impairment of the central nervous system manifested as cognitive dysfunction caused by metabolic or structural changes is a severe progressive vascular complication of type 1 diabetes mellitus (T1DM). Significant difficulties in the diagnosis of cognitive dysfunction are associated with subjective diagnostic techniques. Objective. To identify the role of neurospecific markers in the diagnosis of cognitive dysfunction in patients with T1DM. Materials and Methods. A total of 58 patients with T1DM aged 16?30 years were included in this study. The control group included 29 healthy young adults matched by gender and age. The survey included clinical and laboratory examinations, psychological testing and magnetic resonance imaging (MRI) of the brain. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairment. The levels of neurospecific proteins (S100, glial fibrillary acidic protein and myelin basic protein) were determined to identify early markers of cognitive impairment. MRI of the brain was performed using a Siemens Magnetom 1.0 T system to assess structural changes in the central nervous system. Results. The study revealed increased levels of all neurospecific proteins, which correlated with parameters of hyperglycaemia and cognitive deficit (MoCA scores of
BACKGROUND: According to research, only 38% of patients reach glycated hemoglobin targets. It is possible to improve the effectiveness of medical care for children with T1D using modern technologies, including continuous glucose monitoring (CGM). AIMS: To evaluate the effectiveness of outpatient monitoring of children and adolescents with T1D with regular use of professional continuous glucose monitoring. METHODS: The inclusion criteria: age 812 years; T1D at least 1 year; insulin therapy by multiple injections of insulin; inadequate glycemic control of T1D: НbА1с level of 7.5% and higher and / or children and adolescents with frequent episodes of hypoglycemia (usually 4 times a week) or with a history of severe hypoglycemia; signed informed consent. All patients initially and 12 weeks after inclusion in the study conducted a study of the level of НbА1с, and also performed CGM for 6 days. Based on the results of CGM, glycemia indicators and daily doses of insulin were recorded, treatment was evaluated and corrected, and recommendations for self-monitoring were made. Glucose monitoring was carried 120144 hours using the blind method iPro2 (Medtronic, USA). RESULTS: In all, 99 children aged 818 years were included in the study in all centers. The decrease in the level of НbА1с by the end of the study was 0.72%, while the proportion of patients who reached the target level of НbА1с (defined as 7.5%) was statistically significantly higher at the end of the study (15.5% and 2%, respectively; p0.05). During the study, patients showed a trend towards a decrease in the average level and variability of glycemia by the end of the study, however, statistical significance was achieved only in relation to the average level of glycemia (p=0.04). Conducted insulin therapy, determined by the average daily doses of long-acting and short-acting insulin, did not statistically significantly change at the end of the study. The frequency of DKA episodes and severe hypoglycemia did not statistically significantly differ from the initial level. CONCLUSIONS: For children with poor glycemic control of T1D, the use of professional CGM is effective in terms of glycemic control and a safe method.
Сахарный диабет (СД) 1-го типа считается метаболическим расстройством, приводящим к многофакторному отрицательному воздействию на органы-мишени, одновременно является важным фактором риска в развитии когнитивных нарушений, проблема профилактики и лечения которых в настоящее время занимает одно из центральных мест в современной эндокринологии и неврологии. Цель исследования-оценить современные методики реабилитации в коррекции когнитивных нарушений у пациентов с СД 1-го типа. Были обследованы 50 пациентов с СД 1-го типа в возрасте от 18 до 45 лет, всем пациентам измеряли уровни гликемии натощак, гликированного гемоглобина (HbA1c). Проведена рандомизация: пациенты 1-й группы проходили когнитивный тренинг с использованием компьютеризированной программы Happy Neuron Pro 2 раза в неделю по 45 минут; 2-я группа занималась лечебной физкультурой на базе спортивно-оздоровительного комплекса ФГБОУ ВО СибГМУ 2 раза в неделю по 60 минут. При оценке уровня HbA1c было отмечено его большее снижение в 1-й группе по сравнению со 2-й группой (0,7% и 0,3% соответственно). Когнитивные функции улучшились в обеих группах реабилитации в среднем на 2 балла. Использование методик двигательной и компьютерной реабилитации улучшает когнитивные функции у пациентов с СД 1-го типа. Использование компьютеризированного тренинга приводит к значимому улучшению показателей углеводного обмена. Ключевые слова: современные технологии, когнитивная реабилитация, сахарный диабет 1-го типа
The problem of cognitive dysfunction is currently of interest to doctors of various specialties, since this complication is accompanied by many systemic diseases that involve the central nervous system in the pathological process. However the diagnosis of such violations is given insufficient attention due to the lack of objective methods of verification of this diagnosis. The article presents modern ideas on the possibilities of proton magnetic resonance spectroscopy (1H-MPC) in the diagnosis of cognitive dysfunction in patients with type 1 diabetes mellitus. The role of both hypoglycemia and hyperglycemia in the formation of cognitive dysfunction is considered. The relationship between the state of carbohydrate metabolism and the disorders detected by 1H-MPC is shown.
With an ageing of population and a splurging epidemic of diabetes mellitus (DM), the prevalence of complications associated with pathology of the central nervous system are expected to increase, which in the future may have serious consequences for public health. It is known that one of the main manifestations of brain damage in type 1 diabetes is cognitive impairment, which is possibly associated with the peculiarities of vascularization and interhemispheric asymmetry, which requires in-depth analysis using modern neuroimaging methods. The aim of the study is to assess the symmetry of structural, metabolic and neurovascularization changes in the brain in patients with type 1 diabetes and cognitive impairment. The study included 120 patients with type 1 diabetes aged 18 to 45 years suffering from cognitive impairment, and 30 people without cognitive decline which constituted the control group. Neuropsychological testing included the Montreal Cognitive Dysfunction Assessment Scale (MoCA test). For neuroimaging methods, standard magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), contrast and non-contrast-enhanced perfusion were used. Statistical processing was carried out using the SPSS Statistic 2020 software. In patients with type 1 diabetes with cognitive impairment, as manifested by impaired memory and/or attention, perfusion imaging revealed the presence of brain asymmetry zones. Standard MRI allowed to demonstrate changes in the white, gray matter and hippocampus in the right hemisphere. The results obtained were refined taking into account the topical localization, so during the perfusion study, regions with asymmetric blood flow were identified - namely, the white matter of the frontal lobe and the gray matter in the occipital lobe. Spectroscopy of the brain revealed that it was in these areas of the brain that the most significant metabolic disorders were noted – in the form of significantly altered ratio of N-acetylaspartate (NAA) / choline (Cho) on the left, along with the asymmetry in phosphocreatine level (Cr 2) on the right. In conclusion, early preclinical predictive diagnostics with the use of modern neuroimaging methods allows for timely detection of impaired vascularization and brain metabolism in this group of patients.
Основным показателем компенсации сахарного диабета (СД) является определение уровня гликированного гемоглобина (HbA1c), который отображает лишь средний уровень гликемии. Непрерывный мониторинг гликемии (НМГ) выявляет суточные экскурсии гликемии-вариабельность гликемии (ВГ) и ее специфические индексы, что позволяет практическому врачу принять верное и правильное решение относительно тактики лечения пациента для достижения компенсации заболевания. Цель: провести сравнительный анализ гликированного гемоглобина и индексов вариабельности гликемии для прогнозирования степени компенсации сахарного диабета 1 типа. В исследование было включено 120 пациентов с СД 1 типа. Благодаря технологиям НМГ все пациенты отправляли гликемические отчеты врачу для получения рекомендаций. Обследуемым был проведен анализ HbA1c. С помощью калькулятора EasyGV рассчитывались индексы вариабельности гликемии, на основании которых была построена регрессионная нейросетевая модель в среде статистических вычислений типа R с помощью программного пакета Neuralnet. При использовании НМГ у пациентов с СД 1 типа отмечалось достоверное улучшение индексов вариабельности гликемии к концу исследования. HbA1c в группе дистанционного наблюдения снизился на 1,95% (р≤0,000), в группе очного наблюдения уменьшился на 0,8% (р≤0,000), в группе стандартной терапии увеличился на 0,05% при р=0,546. Дистанционный мониторинг подтверждает свою клинико-метаболическую эффективность в сравнении с другими моделями наблюдения пациентов с сахарным диабетом 1 типа. Оптимальной оказалась модель на основе многослойного перцептрона с высоким значением коэффициента детерминации R 2 =0,987, что свидетельствует о высокой достоверности прогнозирования компенсации заболевания, что позволяет спрогнозировать осложнения и обеспечить персонализированный подход в лечении пациентов с сахарным диабетом 1 типа. Ключевые слова: сахарный диабет 1 типа; дистанционный мониторинг; вариабельность гликемии; нейросетевая модель.
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