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

成人 2 型糖尿病患者脑组织完整性与自我护理能力之间的关系

基本信息

批准号：
10160960
负责人：
SARAH E CHOI
金额：
$ 52.96万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10160960
关键词：
Address Adult Age American Anxiety Area Behavior Blood Glucose Blood Vessels Body mass index Brain Brain Injuries Cessation of life Chronic Clinical Cognition Cognitive Complex Complications of Diabetes Mellitus Country Development Diabetes Mellitus Diagnosis Diffusion Magnetic Resonance Imaging Economic Burden Education Emotional Exercise Gender Glycosylated hemoglobin A Health Healthcare Healthy Eating Hippocampus (Brain)Imaging Techniques Impaired cognition Impairment Individual Injury Intervention Life Expectancy Link Longitudinal Studies Magnetic Resonance Imaging Measures Memory Mental Depression Moods Morbidity - disease rate Neuronal Plasticity Newly Diagnosed Non-Insulin-Dependent Diabetes Mellitus Outcome Patients Performance Persons Pharmaceutical Preparations Physical activity Pilot Projects Prefrontal Cortex Premature Mortality Progressive Disease Questionnaires Regimen Reporting Research Risk Reduction Role Sampling Self Care Site Structure Testing Thinking Time Training United States affective disturbance blood glucose regulation brain tissue brain volume clinical practice cognitive ability cognitive control cognitive testing comparative cost design diabetes control diabetes self-management disability follow-up gender difference glucose monitor glycemic control high risk improved mortality non-diabetic novel therapeutic intervention novel therapeutics patient population prevent public health priorities thiamine supplementation tissue injury

项目摘要

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.

项目总结/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（T2DM）。T2DM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T2DM进展，以及降低过早死亡率。T2DM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T2DM患者中很常见，与更差的T2DM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T2DM自我护理、大脑结构、认知和/或情绪状态之间的关系尚未报告。此外，葡萄糖控制状态的长期影响/作用（如通过血红蛋白A1C [A1C]）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T2DM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，A1C水平发生了变化。然而，T2DM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、A1C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）、T2DM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 T2DM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T2DM和年龄和性别匹配非DM健康对照受试者，以及T2DM和对照组的性别之间; 2）评估T2DM和对照组之间的关系 T2DM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A1C水平与T2DM受试者大脑变化的相关性;以及4）检查T2DM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，T2DM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T2DM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T2DM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A1C水平的影响之间的关系在T2DM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T2DM自我护理和健康结局。