Relationships Between Brain Tissue Integrity and Self-Care Abilities in Adults with Type 2 Diabetes

项目概要/摘要 糖尿病是一种慢性进行性疾病，困扰着近3000万美国人和90-95%的美国人。 这些个体患有2型糖尿病（T2 DM）。T2 DM自我护理不良是高发病率的主要原因， 死亡率，因为良好的自我护理可改善血糖控制，预防或延迟T2 DM进展，以及 降低过早死亡率。T2 DM自我护理方案复杂且具有挑战性，需要完整的认知能力 能力和情绪功能。然而，认知和情绪功能障碍在T2 DM患者中很常见， 与更差的T2 DM自我护理行为相关。认知能力与特定的大脑区域（前额叶 皮质;海马），以及T2 DM自我护理、大脑结构、认知和/或情绪状态之间的关系 还没有报道。此外，葡萄糖控制状态的长期影响/作用（如通过 血红蛋白A1 C [A1 C]）对这些关系的影响尚不清楚。使用非侵入性脑部磁共振 初步研究发现，在认知和情绪控制方面， 影响2型糖尿病自理能力的部位（前额叶皮层[执行思维]、海马[记忆和 情绪]），并将这些变化与T2 DM自我护理联系在一起，在一个小样本的受试者（n=9）。调查结果还表明， 大脑发生了显著变化，A1 C水平发生了变化。然而，T2 DM受试者数量少限制了我们的研究。 控制重要协变量的能力，如年龄、性别、A1 C和体重指数。 使用两组比较设计，我们将检查大脑的完整性在认知和情绪控制领域 (MRI/扩散张量成像）、T2 DM自我护理（糖尿病自我护理活动量表总结）和认知 （蒙特利尔认知评估问卷）和情绪功能（贝克抑郁和贝克焦虑 T2 DM组60例，健康对照组60例。具体目标是：1）比较大脑结构（前 额叶皮质和海马），情绪和认知评分之间的T2 DM和年龄和性别匹配 非DM健康对照受试者，以及T2 DM和对照组的性别之间; 2）评估T2 DM和对照组之间的关系 T2 DM受试者的大脑变化与自我护理管理以及情绪和认知评分之间的关系; 3） 确定A1 C水平与T2 DM受试者大脑变化的相关性;以及4）检查T2 DM受试者大脑变化， 时间（脑可塑性或组织损伤进展的纵向研究）。 总之，T2 DM结局取决于自我护理能力，而自我护理能力可能受到认知和 情绪，但T2 DM自我护理，认知，情绪和大脑变化之间的关系尚不清楚。的 拟议的研究将检查T2 DM和健康受试者之间的大脑变化，以及性别差异， 并研究大脑变化与自我护理，情绪，认知和A1 C水平的影响之间的关系 在T2 DM受试者中。本研究的信息可能会通过识别和检测影响临床实践 新的治疗干预，以保护或恢复大脑，减少或防止认知和情绪 功能障碍，从而改善这一高风险患者人群的T2 DM自我护理和健康结局。

PROJECT SUMMARY/ ABSTRACT Diabetes mellitus is a chronic progressive disease that afflicts almost 30 million Americans and 90-95% of these individuals have type 2 diabetes (T2DM). Poor T2DM self-care is a major cause of high morbidity and mortality, as excellent self-care improves glycemic control, prevents or delays the T2DM progression, and reduces premature mortality. T2DM self-care regimen is complex and challenging, and requires intact cognitive abilities and mood function. However, cognitive and mood dysfunctions are common in T2DM patients and are associated with worse T2DM self-care behaviors. Cognitive abilities are linked to specific brain areas (pre-frontal cortices; hippocampus), and relationships between T2DM self-care, brain structure, cognition and/or mood status have not been reported. Furthermore, the long-term impact/role of glucose control status (as measured by hemoglobin A1C [A1C]) on these relationships is unknown. Using non-invasive brain magnetic resonance imaging (MRI) procedures, preliminary studies found significant brain changes in cognitive and mood control sites that influence T2DM self-care abilities (pre-frontal cortices [executive thinking], hippocampus [memory and mood]) and linked these alterations to T2DM self-care in a small sample of subjects (n=9). Findings also indicated significant brain changes with altered A1C levels. However, the small number of T2DM subjects restricted our ability to control for important covariates, such as age, gender, A1C, and body mass index. Using a two-group comparative design, we will examine brain integrity in cognitive and mood control areas (MRI/diffusion tensor imaging), T2DM self-care (Summary of Diabetes Self-Care Activities scale), and cognitive (Montreal Cognitive Assessment questionnaire) and mood functions (Beck Depression and Beck Anxiety questionnaires) in 60 T2DM and 60 healthy controls. Specific aims are to: 1) compare brain structures (pre- frontal cortices and hippocampus), mood, and cognition scores between T2DM and age- and gender-matched non-DM healthy control subjects, as well as between genders in T2DM and controls; 2) evaluate the relationships between brain changes and self-care management and mood and cognitive scores in T2DM subjects; 3) determine associations of A1C levels on brain changes in T2DM subjects; and 4) examine brain changes over time (longitudinal study for brain plasticity or tissue injury progression). In summary, T2DM outcomes are dependent upon self-care abilities which can be impacted by cognition and mood, but the relationships between T2DM self-care, cognition, mood, and brain changes remain unclear. The proposed study will examine brain changes between T2DM and healthy subjects, as well as gender differences, and investigate relationships between brain changes and self-care, mood, cognition, and impact of A1C levels in T2DM subjects. Information from this study could impact clinical practice through the identification and testing of novel therapeutic interventions to protect or restore the brain, minimize or prevent cognitive and mood dysfunction, and thus, improve T2DM self-care and health outcomes in this high-risk patient population.