Psychological Care as an Interdisciplinary Approach in the Management of Diabetes: A Narrative Review of Literature

Objective: Diabetes, a serious chronic disease, demands a lot of patients in terms of daily self-care and often complicated treatment. Psychological problems are prevalent among people with diabetes. Burden with daily restrictions to diet and activity, risks of the treatment, fear of losing metabolic control and disease progression may furthermore reduce quality of life and aggravate psychological condition. This paper provides a current overview of prevalence, screening and general psychological managements in diabetes according to the worldwide recommendations. In addiction it updates the medical literature refer to Poland. Materials and methods: The search was conducted in Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect. The final set of 75 articles, include 33 papers that refer to psychological condition assessmenttools. Results: The analysis for this review has been packaged into themes in order to generate a very useful and practical tool for all health professionals. It summarized in systematic and comprehensive way all psychological states that can appear in patients with diabetes. The most prevalent and important problems are: diabetes distress, depression, anxiety disorders, disordered eating behavior, and cognitive impairment/dementia. Conclusions: All worldwide guidelines strongly recommendpsychological and social care as integrated part of the management of the diabetes. Healthy psychological state with proper screening, monitoring and the management could help in reaching therapeutic success and better quality of life

Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: a systematic review and meta-analysis

Aims: To examine the bi-directional relationship, whereby hypoglycaemia is a risk factor for dementia, and where dementia increases risk of hypoglycaemia in older patients with diabetes mellitus treated with glucose-lowering agents.  Methods: We searched MEDLINE and EMBASE over a 10-year span from 2005 to 2015 (with automated PubMed updates to August 2015) for observational studies of the association between hypoglycaemia and cognitive impairment or dementia in participants aged >55 years. Assessment of study validity was based on ascertainment of hypoglycaemia, dementia and risk of confounding. We conducted random effects inverse variance meta-analyses, and assessed heterogeneity using the I2 statistic.  Results: We screened 1177 citations, and selected 12 studies, of which nine were suitable for meta-analysis. There were a total of 1 439 818 participants, with a mean age of 75 years. Meta-analysis of five studies showed a significantly increased risk of dementia in patients who had hypoglycaemic episodes: pooled odds ratio 1.68 [95% confidence interval (CI) 1.45, 1.95]. We also found a significantly increased risk of hypoglycaemia in patients with dementia: pooled odds ratio from five studies 1.61 (95% CI 1.25, 2.06). Limitations of the study were heterogeneity in the meta-analysis, and uncertain ascertainment of dementia and hypoglycaemic outcomes and temporal relationships. Publication bias may have favoured the reporting of more significant findings.  Conclusions: Our meta-analysis shows a bi-directional relationship between cognitive impairment and hypoglycaemia in older patients. Glucose-lowering therapy should be carefully tailored and monitored in older patients who are susceptible to cognitive decline

Glycaemic control in type 2 diabetes patients and its predictors: a retrospective database study at a tertiary care diabetes centre in Ningbo, China

Objectives: The objectives of the study were to assess glycaemic control in patients with type 2 diabetes (T2DM) at a tertiary care diabetes centre in Ningbo, China and to determine factors that independently predict their glycaemic control. Design: Retrospective cross-sectional study using an existing database, the Diabetes Information Management System. Setting: Tertiary care diabetes centre in Ningbo, China. Participants: The study included adult patients with T2DM, registered and received treatment at the diabetes centre for at least six consecutive months. The study inclusion criteria were satisfied by 1387 patients, from 1 July 2012 to 30 June 2017. Primary outcome measure: Glycaemic control (poor was defined as glycated haemoglobin (HbA1c)>=7% or fasting blood glucose (FBG)>7.0 mmol/L). Results: In terms of HbA1c and FBG, the 5-year period prevalence of poor glycaemic control was 50.3% and 57.3%, respectively. In terms of HbA1c and FBG, the odds of poor glycaemic control increased with the duration of T2DM (>1 to 2 years: OR 1.84, 95% CI 1.06 to 3.19; >2 to 4 years: 3.32, 1.88 to 5.85 and >4 years: 5.98, 4.09 to 8.75 and >1 to 2 years: 2.10, 1.22 to 3.62; >2 to 4 years: 2.48, 1.42 to 4.34 and >4 years: 3.34, 2.32 to 4.80) and were higher in patients residing in rural areas (1.68, 1.24 to 2.28 and 1.42, 1.06 to 1.91), with hyperlipidaemia (1.57, 1.12 to 2.19 and 1.68, 1.21 to 2.33), on diet, physical activity and oral hypoglycaemic drug (OHD) as part of their T2DM therapeutic regimen (1.80, 1.01 to 3.23 and 2.40, 1.36 to 4.26) and on diet, physical activity, OHD and insulin (2.47, 1.38 to 4.41 and 2.78, 1.58 to 4.92), respectively. Conclusions: More than half of patients with T2DM at the diabetes centre in Ningbo, China have poor glycaemic control, and the predictors of glycaemic control were identified. The study findings could be taken into consideration in future interventional studies aimed at improving glycaemic control in these patients

The role of adiponectin receptors in the regulation of synaptic transmission in the hippocampus

In the last two decades adiponectin, member of the adipokines family, gained attention because of its unique antidiabetic effects. However, the presence in the brain of adiponectin receptors and adiponectin itself raised interest because of the possible association with neuropsychiatric diseases. Indeed, clinical studies found altered concentration of adiponectin both in plasma and cerebrospinal fluid in seeveral pathologies including depression, multiple sclerosis, Alzheimer’s disease and stroke. Moreover, recent preclinical studies also suggest its involvement in different physiological functions. Despite this evidence very few studies attempted to elucidate the functional role of adiponectin at the synapse.To address this question, here we investigated the effect of Adiporon, an agonist of both adiponectin receptors on synaptic transmission and LTP at Schaffer-collateral CA1 pathway. Surprisingly, increasing concentration of Adiporon correlated with lower CA1-LTP levels and paired-pulse ratio, whereas basal transmission was always preserved. Collectively, our data show that the adiponectin system, beyond its involvement in metabolic diseases, plays also a critical role in synaptic activity thereby representing a putative target for the treatment of synaptic pathologies

CNS targets of adipokines

This is the author accepted manuscript. The final version is available from American Physiological Society via the DOI in this record.Our understanding of adipose tissue as an endocrine organ has been transformed over the last twenty years. During this time a number of adipocyte-derived factors or adipokines have been identified. This paper will review evidence for how adipokines acting via the central nervous system (CNS) regulate normal physiology and disease pathology. The reported CNS-mediated effects of adipokines are varied and include the regulation of energy homeostasis, autonomic nervous system activity, the reproductive axis, neurodevelopment, cardiovascular function, and cognition. Due to the wealth of information available and the diversity of their known functions, the archetypal adipokines leptin and adiponectin will be the focused on extensively. Other adipokines with established CNS actions will also be discussed. Due to the difficulties associated with studying CNS function on a molecular level in humans, the majority of our knowledge, and as such the studies described in this paper, comes from work in experimental animal models; however, where possible the relevant data from human studies are also highlighted

Factors associated with poor glycaemic control in type 2 diabetic elderly patients with mild cognitive impairment

Introduction and objective. Recently, data has indicated a higher incidence of mild cognitive impairment (MCI) in patients with diabetes. Old age is a risk factor for cognitive deterioration and dementia. The aim of the study was to find the factors associated with poor glycaemic control in type 2 diabetic elderly patients with MCI. Materials and method. A cross-sectional study was conducted on 87 diabetic patients with MCI in an outpatient clinic. All subjects were screened for MCI using the Montreal Cognitive Assessment (MoCA). Detailed medical history and collection of blood test samples were performed. Results. 83.9% of participants had poor glycaemic control. A positive correlation was found between HbA1c level and number of visit to a doctor per year, number of co-morbidities, duration of T2DM, triglycerides and fasting glucose level; and a negative correlation between HbA1c level and years of education, HDL cholesterol level and MoCA score. The univariate logistic regression models revealed factors which are associated with poor glycemic control are: less years of education, higher no of visit to doctor per year, increased number of co-morbidities, presence of CVD, retinopathy, higher levels of triglycerides and fasting glucose, lower level of HDL cholesterol, lower MoCA score. Multivariable model revealed that higher plasma levels of fasting glucose and triglycerides are significant predictors. Conclusions. There is a high prevalence of poor glycemic control patients among elderly diabetics with MCI. Higher plasma levels of fasting glucose and triglycerides seems to be the most important predictors of poor glycemic control, however father larger studies are needed to elucidate these relationships

Mild Cognitive Impairment and Depressive Symptoms in Elderly Patients with Diabetes: Prevalence, Risk Factors, and Comorbidity

The aim of the study was to estimate the prevalence of mild cognitive impairment (MCI), depressive syndrome cases, and its comorbidity, and to identify predictors of these conditions. Methods. 276 diabetics elders were screened for MCI and depressive symptoms. Detailed information of history of diabetes, and data of BMI, HbA1c, and blood lipids were collected. Results. The prevalence of MCI was 31.5%, depressive syndrome was 29.7%, and MCI with coexisting depressive mood was 9.1%. The logistic regression analysis revealed that variables which increased the likelihood of having been diagnosed with MCI were: higher HbA1c level, previous CVD, hypertension, retinopathy, increased number of comorbidities, and less years of formal education. Significant predictors of having a depressive mood included female gender, single marital status, current and past smoking status, lack of physical activity, higher BMI and total cholesterol level, increased number of comorbidities, history of hypoglycemia, and insulin treatment. Factors associated with both MCI and depressive syndrome were female gender, single marital status, past smoking status, retinopathy, previous CVD or stroke, increased number of comorbidities, and insulin treatment. Conclusions. Depressive symptoms, MCI, and its comorbidity are common in elderly subjects with type 2 diabetes. Systematic screening could result in the identification of high-risk patients

Serum Soluble Adhesion Molecules and Markers of Systemic Inflammation in Elderly Diabetic Patients with Mild Cognitive Impairment and Depressive Symptoms

The aim of the study was to determine the serum levels of soluble adhesion molecules and hs-CRP in elderly diabetics with mild cognitive impairment (MCI) alone or with depressive symptoms. Methods. 219 diabetics elders were screened for psychiatric disorders and divided: group 1, MCI without depressive mood; group 2, MCI with depressive mood; group 3, controls. Data of biochemical parameters and biomarkers were collected. Results. In groups 1 and 2 levels of all biomarkers were significantly higher as compared to controls. The highest level of hs-CRP and sICAM-1 was detected in group 2. SVCAM-1 and sE-selectin levels were also the highest in group 2; however they did not significantly differ as compared to group 1. MoCA score was negatively correlated with all biomarkers in group 1. The logistic regression model showed that variables which increased the likelihood of having depressive syndrome in MCI patients were older age, stroke, neuropathy, increased number of comorbidities, and higher sICAM-1 level. Conclusions. We first demonstrated that elderly diabetic patients with MCI, particularly those with depressive mood have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation. Coexisting depressive syndrome in patients with MCI through common inflammatory pathways may result in augmentation of psychiatric disorders

Serum Soluble Adhesion Molecules and Markers of Systemic Inflammation in Elderly Diabetic Patients with Mild Cognitive Impairment and Depressive Symptoms

The aim of the study was to determine the serum levels of soluble adhesion molecules and hs-CRP in elderly diabetics with mild cognitive impairment (MCI) alone or with depressive symptoms. Methods. 219 diabetics elders were screened for psychiatric disorders and divided: group 1, MCI without depressive mood; group 2, MCI with depressive mood; group 3, controls. Data of biochemical parameters and biomarkers were collected. Results. In groups 1 and 2 levels of all biomarkers were significantly higher as compared to controls. The highest level of hs-CRP and sICAM-1 was detected in group 2. SVCAM-1 and sE-selectin levels were also the highest in group 2; however they did not significantly differ as compared to group 1. MoCA score was negatively correlated with all biomarkers in group 1. The logistic regression model showed that variables which increased the likelihood of having depressive syndrome in MCI patients were older age, stroke, neuropathy, increased number of comorbidities, and higher sICAM-1 level. Conclusions. We first demonstrated that elderly diabetic patients with MCI, particularly those with depressive mood have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation. Coexisting depressive syndrome in patients with MCI through common inflammatory pathways may result in augmentation of psychiatric disorders

Serum levels of inflammatory markers in depressed elderly patients with diabetes and mild cognitive impairment.

The aim of the study was to determine the serum levels of CRP, IL-6 and TNF-α in elderly diabetic patients with depressive syndrome alone or with coexisting mild cognitive impairment (MCI).276 diabetics elders were screened for depressive symptoms (using Geriatric Depression Scale: GDS-30) and MCI (using the Montreal Cognitive Assessment: MoCA score). Data of HbA1c, blood lipids and inflammatory markers levels were collected.In all groups of patients levels of CRP, IL-6 and TNF-α were significantly higher as compared to controls. The highest level of inflammatory markers was detected in group with depressive mood and coexisting MCI, however IL-6 level didn't significantly differ as compared to MCI group. We founded correlations between all inflammatory markers in group of patients with depressive mood and in group of subjects with depressive symptoms and coexisting MCI. GDS-30 score was correlated with levels of inflammatory markers in group with depressive mood, and with levels of CRP and TNF-α in group with depressive mood and coexisting MCI. In the group with depressive mood and coexisting MCI we founded that MoCA score was negatively correlated with CRP and TNF-α levels; and HbA1c level was positively correlated with all inflammatory markers. The univariate logistic regression models revealed that variables which increased the likelihood of having been diagnosed with MCI in depressed patients were: higher levels of HbA1c, CRP, IL-6 and TNF-α, previous CVD or stroke, increased number of co-morbidities and microvascular complications, older age, less years of formal education. The multivariable model showed that previous CVD, higher HbA1c and IL-6 levels are significant factors.We demonstrated that the presence of depressive syndrome is associated with higher levels of inflammatory markers in elderly patients with diabetes. The presence of MCI in these depressed subjects has additive effect on levels of inflammatory mediators