Abstract

Objective— to study the morphometric characteristics of the brain in patients with type 1 diabetes mellitus (DM) receiving insulin therapy in diff erent modes, taking into account the variability of glycemia.Material and methods.120 patients with type 1 diabetes, living in Tomsk and the Tomsk Region, were examined. All patients were divided into 2 groups: group 1 — patients receiving insulin in the base-bolus regimen of multiple insulin injections (MII), group 2 — using pump insulin therapy by continuous subcutaneous infusion of insulin using a wearable dispenser (CSII). Patients took this therapy for at least 6 months before inclusion in the study. All patients underwent a general clinical examination, testing of cognitive functions using the Montreal scale (MoCA test), continuous monitoring of blood glycemia (CMG) using iPro™ 2 Professional Continuous Glucose Monitoring (Medtronic, USA), FreeStyle Libre (Abbot, USA) in for 14 days, standard magnetic resonance imaging (MRI) on a 1.5 Tesla apparatus in axial, sagittal and coronal projections using T2, TE, T1, and using programs that suppress the signal of free water. We processed the results of MRI using Free Surfer (USA) and recon-all segmentation algorithm. Statistical analysis was performed using the R-system software package.Results.It was found that in both groups with type 1 diabetes there was a decrease in cognitive functions. It has been shown that CSII is associated with the best completion of the MoCA test. In addition, it has been reported that more frequent episodes of diabetic ketoacidosis and increased glycated hemoglobin (HbA1c) are the main causes of cognitive impairment in this group of patients. Changes in the morphometric parameters of the brain are interconnected with glycemic variability.Conclusion.In patients with type 1 diabetes, cognitive impairment associated with acute and chronic hyperglycemia was verifi ed. Morphometric features of brain changes are more dependent on glycemic variability. CSII helps improve cognitive function.

Highlights

  • Цель: изучить морфометрические характеристики головного мозга у пациентов с сахарным диабетом (СД) 1-го типа, получающих инсулинотерапию в разных режимах, с учетом вариабельности гликемии

  • Всем больным проводилось общеклиническое обследование, тестирование когнитивных функций с помощью Монреальской шкалы (MoCA-тест), непрерывное мониторирование гликемии (НМГ) с помощью приборов iProTM2 Professional Continuous Glucose Monitoring (Medtronic, США), FreeStyle Libre (Abbot, США) в течение 14 сут, стандартная магнитно-резонансная томография (МРТ) на аппарате 1,5 Тесла в аксиальной, сагиттальной и корональной проекциях с использованием Т2, TE, Т1 и применением программ с подавлением сигнала свободной воды

  • All patients were divided into 2 groups: group 1 — patients receiving insulin in the base-bolus regimen of multiple insulin injections (MII), group 2 — using pump insulin therapy by continuous subcutaneous infusion of insulin using a wearable dispenser (CSII)

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Summary

Оригинальные исследования

Самойлова Ю.Г.1, Матвеева М.В.1, Тонких О.С.1, Лейман О.П.1, Фимушкина Н.Ю.1, Кудлай Д.А.2, Воржцова И.Н.1, Харахулах М.И.3. Цель: изучить морфометрические характеристики головного мозга у пациентов с сахарным диабетом (СД) 1-го типа, получающих инсулинотерапию в разных режимах, с учетом вариабельности гликемии. All patients were divided into 2 groups: group 1 — patients receiving insulin in the base-bolus regimen of multiple insulin injections (MII), group 2 — using pump insulin therapy by continuous subcutaneous infusion of insulin using a wearable dispenser (CSII). All patients underwent a general clinical examination, testing of cognitive functions using the Montreal scale (MoCA test), continuous monitoring of blood glycemia (CMG) using iProTM 2 Professional Continuous Glucose Monitoring (Medtronic, USA), FreeStyle Libre (Abbot, USA) in for 14 days, standard magnetic resonance imaging (MRI) on a 1.5 Tesla apparatus in axial, sagittal and coronal projections using T2, TE, T1, and using programs that suppress the signal of free water. Keywords : type 1 diabetes mellitus; multiple injections of insulin; continuous subcutaneous insulin infusion; cognitive impairment; glycemic variability; morphometry

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