Middle-aged Type 2 Diabetes Mellitus Patients Research Articles

Assessment of Psoas Muscle Index in Middle-Aged Type 2 Diabetes Patients: Impact of Insulin Therapy on Sarcopenia

Objective: Sarcopenia, characterized by progressive skeletal muscle loss, poses significant health risks, including physical impairment and mortality. The relationship between sarcopenia and insulin resistance suggests insulin therapy’s potential in preserving muscle mass, particularly in Type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate the Psoas Muscle Index (PMI) via computed tomography (CT) in middle-aged T2DM patients on insulin therapy versus oral antidiabetic drugs (OAD) and controls. Methods: This retrospective study included 107 middle-aged T2DM patients undergoing non-contrast CT scans and 58 age-matched controls. CT images were analyzed to calculate PMI. Statistical analysis included Chi-square tests, independent samples t-tests, Mann–Whitney U tests, and correlation analyses. Results: Insulin-treated patients exhibited higher PMI than OAD users (p < 0.001), while OAD users had lower PMI than controls (p < 0.001). No significant difference was found between insulin-treated patients and controls (p = 0.616). Negative correlations were observed between T2DM duration/age and PMI across all groups, with a positive correlation between T2DM duration and BMI observed in the OAD group. Conclusions: Insulin therapy in T2DM patients, regardless of age or disease duration, positively impacts muscle mass, highlighting its potential in preserving muscular health and advocating for tailored treatment strategies in T2DM management.

Diabetic peripheral neuropathy: age-stratified glycemic control.

We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM). A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019. In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019. Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.

Relationships Between Body Composition and Cognitive Impairment in Hospitalised Middle-Aged Type 2 Diabetic Patients.

The aim of this study was to elucidate the relationship between specific body composition and the risk of Cognitive Impairment (CI) in middle-aged Type 2 Diabetes Mellitus (T2DM) patients. This cross-sectional study included 504 hospitalized patients with T2DM from the Department of Endocrinology and Metabolism of the Tianjin Union Medical Center. Subjects were grouped by sex, and cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The relationship between body composition and cognitive ability was investigated with the use of linear regression analysis. The association between body composition and CI risk was determined by logistic regression analysis. The prevalence of CI was 39.3% in middle-aged T2DM patients. After adjusting for age, education, marriage status, carotid atherosclerosis, cerebrovascular disease and hemoglobin, multiple linear regression analysis showed that lean mass index (LMI), body mass index (BMI) and appendicular skeletal muscle index (SMI) were significant predictors for the MoCA scores in men (p < 0.05). In addition, BMI (OR 0.913, 95% CI 0.840-0.992) and LMI (OR 0.820, 95% CI 0.682-0.916) were independent protective factors for CI in males. After adjusted for age, education, marriage status, dietary control of diabetes and cerebrovascular disease, visceral obesity (VO, OR 1.950, 95% CI 1.033-3.684) and abdominal obesity (AO, OR 2.537, 95% CI 1.191-5.403) were risk factors for CI in female patients. The results suggest that there may be different mechanisms underlying the relationship of body compositions and cognitive performance between middle-aged male and female patients with T2DM. In addition, our finding of potential determinants of cognitive impairment may facilitate the development of intervention programs for middle-aged type 2 diabetic patients. Nevertheless, more large prospective studies looking at cognition and changes in body composition over time are needed in the future to further support their association.

Correlation between impaired hemodynamic response and cardiopulmonary fitness in middle-aged type 2 diabetes mellitus patients: a case-control study.

Impaired cardiorespiratory fitness (CRF) is a predictor of mortality in patients with type 2 diabetes mellitus (T2DM). It is still not known how the exercise hemodynamic response correlates with CRF. The purpose was to assess the correlation between hemodynamic changes and CRF in middle-aged patients with T2DM. After 1:1 matching by age and sex, 139 T2DM patients and 139 non-T2DM controls who completed the exercise treadmill test were included. Maximal aerobic capacity (VO2max), exercise-induced changes in heart rate (ΔHR), systolic blood pressure (ΔSBP), diastolic blood pressure (ΔDBP), and rate-pressure product (ΔRPP) were measured. HRR1 was calculated as the maximum heart rate minus the heart rate after 1min of rest. Compared to the control population, T2DM patients had decreased ΔHR (87 (77, 97) v 93 (84, 104) bpm, p < 0.05), ΔRPP (3833.64 ± 1670.34 v 4381.16 ± 1587.78bpm∙mmHg, p < 0.05), HRR1 (21 (14, 27) v 21 (17, 27) bpm, p < 0.05), and VO2max (32.76 ± 5.63 v 34.68 ± 5.70ml/kg/min, p < 0.05). Multiple linear regression analysis showed that ΔHR and HRR1, yielded a positive correlation with VO2max in T2DM patients (β = 0.325, P < 0.001; β = 0.173, P = 0.01). The presence of impaired hemodynamic response and VO2max in middle-aged T2DM patients and the association of impaired ΔHR, HRR1, and VO2max may indicate a physiological pathway of impaired CRF, and our results support the need for cardiorespiratory screening and individualized treatment of middle-aged T2DM patients.

Hippocampal subfields atrophy contribute more to cognitive impairment in middle-aged patients with type 2 diabetes rather than microvascular lesions.

Neurodegeneration and microvascular lesions are related to cognitive impairment in type 2 diabetes mellitus (T2DM). We aimed to use the volume of hippocampal subfields and the burden of white matter hyperintensities (WMH) as neurodegeneration and microangiopathy markers, respectively, to investigate their potential associations with cognitive impairment in T2DM patients. A total of 76 T2DM patients and 45 neurologically unimpaired normal controls were enrolled between February 2016 to August 2018. All participants underwent structural magnetic resonance imaging (MRI) and Montreal Cognitive Assessment (MoCA). The T2DM patients were divided into the T2DM without mild cognitive impairment (T2noMCI) group (n = 44) and the T2DM with mild cognitive impairment (T2MCI) group (n = 32) according to MoCA scores. We used automatic brain segmentation and quantitative technique to assess the volume of twelve hippocampal subfields and WMH on MRI. We used age, sex, education, and total intracranial volume as our covariates and the Bonferroni method for multiple comparison correction. Both the T2MCI group and T2noMCI group showed significant hippocampal subfields atrophy compared to the controls, which were mainly in the left hippocampal tail, left CA1, bilateral molecular layer, bilateral dentate gyrus, and bilateral CA4 (all p < 0.0042). No significant differences in the volume of total WMH, deep-WMH, and periventricular-WMH were found among the three groups. The HbA1c levels were significantly negatively correlated with hippocampal atrophy, and the MoCA scores were positively correlated with bilateral hippocampal volume in T2DM patients and all samples. Mediation analyses demonstrated that the association of HbA1c levels with cognitive function was mediated by hippocampal subfields volume. Widespread hippocampal atrophies across the subfields have been found in middle-aged T2DM patients, which was positively correlated with the MoCA scores and negatively correlated with the HbA1c levels. The association of HbA1c levels with cognitive function was mediated by some crucial hippocampal subfields volume. In middle-aged patients with T2DM, the neurodegeneration is more strongly associated with cognitive impairment than microvascular lesions. Trail Registeration This study was registered on Clinical-Trails.gov (NCT02738671).

Довжина теломер у хворих на цукровий діабет 2-го типу та її зв’язок із метаболічним профілем

To study leukocyte telomere length and its relationship with metabolic profile 35 patients with metabolic syndrome and type 2 diabetes mellitus (T2DM) and 21 healthy people of middle age (35-59 years) were examined. The anthropometric characteristics of obesity, indicators of lipid and glucose metabolism, alanin aminotransferase (ALT) and high sensitive C-reactive protein levels were studied. The relative average telomere length was determined by the method of monochrome multiplex quantitative real time polymerase chain reaction. Patients with T2DM had higher BMI, waist circumference, higher high sensitive C-reactive protein, ALT and glucose levels and a worse lipid profile (p &lt;0.05). At the same time, the median telomere length did not differ between groups. Nevertheless, in the T2DM group the telomere length inversely correlated with body weight (r = –0.35; p &lt; 0.05), BMI (r = –0.36; p &lt; 0.05), waist circumference (r = –0.34; p &lt; 0.05) and ALT level (r = –0,44; p&lt;0,05) in contrast to healthy subjects. No relationship was found between the telomere length and the level of fasting glycemia, as well as the age of the participants of both groups. Thus, in T2DM patients increase in BMI, waist circumference and ALT level were associated with a shorter leukocyte telomere length. Despite the worse metabolic profile, the telomere length in middle-aged T2DM patients did not differ from that in the control group. This indicates that the leukocyte telomere length is influenced not only by the presence of T2DM and the metabolic profile indicators, but, obviously, by other factors as well.

Type 2 Diabetes Mellitus May Exacerbate Gray Matter Atrophy in Patients With Early-Onset Mild Cognitive Impairment.

BackgroundThe precise physiopathological association between the courses of neurodegeneration and cognitive decline in type 2 diabetes mellitus (T2DM) remains unclear. This study sought to comprehensively investigate the distribution characteristics of gray matter atrophy in middle-aged T2DM patients with newly diagnosed mild cognitive impairment (MCI).MethodsFour groups, including 28 patients with early-onset MCI, 28 patients with T2DM, 28 T2DM patients with early-onset MCI (T2DM-MCI), and 28 age-, sex-, and education-matched healthy controls underwent three-dimensional high-resolution structural magnetic resonance imaging. Cortical and subcortical gray matter volumes were calculated, and a structural covariance method was used to evaluate the morphological relationships within the default mode network (DMN).ResultsOverlapped and unique cortical/subcortical gray matter atrophy was found in patients with MCI, T2DM and T2DM-MCI in our study, and patients with T2DM-MCI showed lower volumes in several areas than patients with MCI or T2DM. Volume loss in subcortical areas (including the thalamus, putamen, and hippocampus), but not in cortical areas, was related to cognitive impairment in patients with MCI and T2DM-MCI. No associations between biochemical measurements and volumetric reductions were found. Furthermore, patients with MCI and those with T2DM-MCI showed disrupted structural connectivity within the DMN.ConclusionThese findings provide further evidence that T2DM may exacerbate atrophy of specific gray matter regions, which may be primarily associated with MCI. Impairments in gray matter volume related to T2DM or MCI are independent of cardiovascular risk factors, and subcortical atrophy may play a more pivotal role in cognitive impairment than cortical alterations in patients with MCI and T2DM-MCI. The enhanced structural connectivity within the DMN in patients with T2DM-MCI may suggest a compensatory mechanism for the chronic neurodegeneration.

Application research of motivational interviewing strategy based on WeChat platform in young and middle-aged patients with type 2 diabetes mellitus

Objective To explore the effects of motivational interviewing strategy based on WeChat platform on blood glucose, self-management behavior and pain degree in young and middle-aged patients with type 2 diabetes mellitus (T2DM) . Methods The convenience sampling method was used to select a total of 84 young and middle-aged patients with T2DM who were admitted to Department of Endocrinology of a ClassⅢ Grade A hospital from August to October 2018 as the research objects. According to the random number table, all patients were divided into the observation group and the control group with 42 cases in each group. The observation group was given the motivational interviewing strategy based on WeChat platform for intervention. The control group received routine diabetes education. Before and 6 months after the intervention, the blood glucose, self-management behavior and pain degree of the patients in the two groups were evaluated. Results After 6 months of intervention, the patients' blood glucose, self-management behavior and pain degree were all better than those in the control group, and the differences were statistically significant (P<0.01) . Conclusions The motivational interview strategy based on WeChat platform can improve the blood glucose level and self-management behavior of young and middle-aged T2DM patients, reduce the degree of pain, and provide a reference for the development of home care and continuous care. Key words: Diabetes mellitus, type 2; Young and middle-aged; WeChat; Motivational interviewing; Blood glucose level; Diabetic pain; Self-management behavior

Relationship Between Self-Care Behavior and Cognitive Function in Hospitalized Adult Patients with Type 2 Diabetes: A Cross-Sectional Study.

PurposeTo investigate the relationship between diabetes self-care behavior and cognitive function of hospitalized young and middle-aged Chinese patients with type 2 diabetes mellitus (T2DM).Patients and MethodsIn this cross-sectional study, young and middle-aged T2DM patients (age range, 35–65 years) were recruited at 4 tertiary hospitals between July 2016 and January 2017. Data pertaining to self-care behavior and cognitive function were collected using two questionnaires (the Summary of Diabetes Self-care Activities [SDSCA] and the Montreal Cognitive Assessment [MoCA], respectively). Multivariate linear regression analysis was performed to assess the correlation between cognitive function and self-care activities.ResultsA total of 140 patients with diabetes were enrolled (mean age, 53.79±7.96 years). The mean duration of T2DM was 10.83±6.76 years. Regarding SDSCA performance, the mean scores for foot care and blood glucose monitoring were 2.20±2.57 and 1.98±2.45, respectively, which were the worst; scores for exercise (4.01±2.58) and diet (3.16±1.89) were better, while scores for medication administration (5.26±2.79) were the best. The prevalence of cognitive impairment was 37.9% (53 patients). After variables adjustment, delayed recall showed a significant correlation with blood sugar monitoring behavior (B =0.224, P=0.019); visual space and executive function (B=0.255, P=0.009) and abstraction (B=−0.337, P=0.001) showed a correlation with foot care behavior.ConclusionCognitive ability affects the self-care behavior of patients with T2DM. Assessment of cognitive function may help inform patient education interventions to improve the self-care behavior of these patients.

Quality of Life in Type 2 Diabetes Mellitus Patients with Neuropsychological Deficits.

We investigated: (i) the cognitive performance of type 2 diabetes mellitus (T2DM) patients compared to healthy control participants and (ii) the Health-related Quality of life (HRQOL) of type 2 diabetics with neuropsychological deficits. We conducted a prospective study in (N=44) T2DM patients and (N=28) demographically matched healthy controls. All participants were assessed with a flexible comprehensive neuropsychological battery of tests that have been standardized in Greece and found to be sensitive in detecting cognitive deficits in type 2 diabetics. They were additionally assessed on measures of general intelligence, general mental state, and depression. They were also administered the WHO QOL-BREF self-report questionnaire to evaluate perceived health-related quality of life. Groups were well matched on baseline demographic characteristics and estimated premorbid intelligence. The groups did not differ on general mental state but varied in the encoding of verbal material, total verbal learning, delayed recall of verbal information, mental information processing speed, phonological and semantic verbal fluency and executive functions, set-shifting. Glycosylated hemoglobin levels and an interaction of age, education, and premorbid intelligence were the most important predictors of domain-specific neuropsychological performance. T2DM patients with deficits in verbal learning, executive functions, set-shifting, and semantic verbal fluency, had significantly lower QOL in the domains of psychological and environmental health, social relationships, and general health, respectively. T2DM patients have cognitive deficits on several domains compared to healthy participants. Domain specific neuropsychological deficits in middle aged T2DM patients have a significant impact on HRQOL.

Selective Impairment of Attentional Networks of Executive Control in Middle-Aged Subjects with Type 2 Diabetes Mellitus.

BackgroundThe influence of type 2 diabetes mellitus (T2DM) on attention has been elusive. The Attention Network Test (ANT) was developed to evaluate the functioning of 3 individual attentional networks: orienting, alerting, and executive control. The purpose of this study was to use the ANT to assess attentional function and its sub-components in T2DM patients ages 40–60 years.Material/MethodsThirty T2DM patients and 30 healthy controls ages 40–60 years were recruited in this investigation. The ANT was used to statistically compare the efficiency among 3 sub-components of the attention networks between middle-aged T2DM patients (n=30) and gender-, age-, and education-matched healthy controls (n=30).ResultsThe ANT demonstrated a significant difference in executive control network between the T2DM patients and healthy controls (t=3.242, P=0.002), whereas no significant difference was observed regarding the domains of alerting (t=0.515, P=0.609) and orienting control (t=0.078, P=0.938) between the T2DM patient group and the healthy control group. Moreover, the mean reaction time in the ANT in the T2DM patients was significantly longer compared with that in the healthy controls (t=3.561, P=0.001).ConclusionsThe ANT reveals significant impairment in the executive control of middle-aged patients diagnosed with T2DM, whereas no significant impairment was observed in the domains of alerting and orienting.

Predictors for Gingival Index in Middle-Aged Asian Indians with Type 2 Diabetes from South India: A Cross-Sectional Observational Study.

Asian Indians develop type 2 diabetes mellitus (T2DM) much earlier as compared to White Caucasians, due to unique phenotypic and genetic architecture. Periodontitis in T2DM patients is often a neglected clinical feature. This study was conducted to derive predictor variables for gingival index in middle-aged Asian Indians with T2DM in a semiurban population of Dravidian ethnicity from Tamil Nadu, India. T2DM patients (n = 232, mean age: 50.6 ± 10.4 years) with periodontitis (n = 123, mean age: 54.3 ± 2.4 years) and without periodontitis (n = 109, mean age: 55.2 ± 3.1 years) were recruited between 2014 and 2016 by purposive sampling method. Dental examinations for pocket depth (PD) and clinical attachment level (CAL) were performed and gingival index was calculated. Fasting venous blood samples were analysed for measures of glycaemia and cholesterol. Significant positive correlation (p < 0.01) was observed for gingival index with glycosylated haemoglobin (HbA1c), pocket depth, presence of T2DM, and clinical attachment level. Stepwise multiple linear regression analysis derived increased pocket depth (p < 0.01), elevated HbA1c (p < 0.01), clinical attachment level (p < 0.01), and presence of diabetes (p < 0.01) as significant predictors (r 2 value = 0.67) for increased gingival index in middle aged patients with T2DM. These variables significantly (p < 0.01) predispose middle-aged T2DM patients to increased gingival index, thus warranting appropriate intervention.

Decision-making in primary onset middle-age type 2 diabetes mellitus: a BOLD-fMRI study

Although type 2 diabetes mellitus (T2DM) is a well-recognized risk factor for dementia, the neural mechanisms that underlying cognitive impairment in T2DM remain unclear. We used functional magnetic resonance imaging (fMRI) during a computerized version of the Iowa Gambling Task to investigate the neural basis of decision making at the initial onset stage of T2DM. Eighteen newly diagnosed middle-aged T2DM patients, with no previous diabetic treatment history, and 18 matched controls were recruited. Results indicated that T2DM patients made more disadvantageous decisions than controls. Compared to healthy subjects, T2DM patients showed decreased activation in the ventral medial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC) and anterior cingulate cortex, and increased activity in the dorsolateral prefrontal cortex, posterior cingulate cortex, insula and occipital lobes. IGT performance positively correlated with changes in brain activation in the VMPFC and OFC in both groups. Moreover, poor glycemic control was associated with decision-making function both in behavioral and brain activity in the VMPFC and OFC in patients. Conclusively, T2DM patients may suffer from weaknesses in their prefrontal cortex functions that lead to poorer decision-making under ambiguity, at least as assessed by the IGT.

Mobile Exergaming for Health\u2014Effects of a serious game application for smartphones on physical activity and exercise adherence in type 2 diabetes mellitus\u2014study protocol for a randomized controlled trial

BackgroundExergaming is a novel approach to increase motivation for regular physical activity (PA) among sedentary individuals such as patients with type 2 diabetes mellitus (T2DM). Because existing exergames do not offer fitness-level adjusted, individualized workouts and are normally stationary (TV bound), thus not enabling PA anywhere and at any time, we developed a smartphone-based, game-like software application (MOBIGAME) specifically designed for middle-aged T2DM patients to induce a healthier, more active lifestyle as part of successful T2DM treatment and management. In a randomized controlled trial we aim to examine whether our smartphone-based game application can lead to increases in daily PA in T2DM patients that are persistent in the mid to long term and whether these increases are greater than those in a control group.MethodsThis study is designed as a randomized controlled trial. We plan to recruit a total of 42 T2DM patients [45-70 years, body mass index (BMI) ≥25 kg/m2, low daily PA, regular smartphone use].The experimental intervention (duration 24 weeks) includes individualized multidimensional home-based exercise and daily PA promotion administered through MOBIGAME. The control intervention consists of a one-time standard lifestyle counseling including the promotion of baseline activities.The primary outcome is daily PA measured as steps per day. Secondary outcome is exercise adherence measured via the usage data from the participants’ smartphones (experimental intervention) and as self-recorded exercise log entries (control intervention).We will test the hypothesis that there will be differences between the experimental and control group with respect to post-interventional daily PA (as well as all other outcomes) using analysis of covariance. For each analysis, an estimate (with 95% confidence interval) of the difference in outcome between both groups will be reported.DiscussionThis research will investigate the effectiveness of a novel smartphone-based, game-like software application to be used as a way to promote regular daily PA among inactive T2DM patients. The results of this trial may have important implications for future PA-promoting interventions and provide relevant information for the general transferability of such applications to be used as part of the treatment in other chronic diseases.Trial registrationClinicalTrials.gov, NCT02657018. Registered on 11 January 2016. Last status update on 3 May 2016. Kofam.ch, SNCTP-number:SNCTP000001652. Registered on 21 January 2016.

Aberrant Brain Regional Homogeneity and Functional Connectivity in Middle-Aged T2DM Patients: A Resting-State Functional MRI Study.

Type 2 diabetes mellitus (T2DM) has been associated with cognitive impairment. However, its neurological mechanism remains elusive. Combining regional homogeneity (ReHo) and functional connectivity (FC) analyses, the present study aimed to investigate brain functional alterations in middle-aged T2DM patients, which could provide complementary information for the neural substrates underlying T2DM-associated brain dysfunction. Twenty-five T2DM patients and 25 healthy controls were involved in neuropsychological testing and structural and resting-state functional magnetic resonance imaging (rs-fMRI) data acquisition. ReHo analysis was conducted to determine the peak coordinates of brain regions with abnormal local brain activity synchronization. Then, the identified brain regions were considered as seeds, and FC between these brain regions and global voxels was computed. Finally, the potential correlations between the imaging indices and neuropsychological data were also explored. Compared with healthy controls, T2DM patients exhibited higher ReHo values in the anterior cingulate gyrus (ACG) and lower ReHo in the right fusiform gyrus (FFG), right precentral gyrus (PreCG) and right medial orbit of the superior frontal gyrus (SFG). Considering these areas as seed regions, T2DM patients displayed aberrant FC, mainly in the frontal and parietal lobes. The pattern of FC alterations in T2DM patients was characterized by decreased connectivity and positive to negative or negative to positive converted connectivity. Digital Span Test (DST) forward scores revealed significant correlations with the ReHo values of the right PreCG (ρ = 0.527, p = 0.014) and FC between the right FFG and middle temporal gyrus (MTG; ρ = −0.437, p = 0.048). Our findings suggest that T2DM patients suffer from cognitive dysfunction related to spatially local and remote brain activity synchronization impairment. The patterns of ReHo and FC alterations shed light on the mechanisms underlying T2DM-associated brain dysfunction and might serve as imaging biomarkers for diagnosis and evaluation.

Hyperactivation of working memory-related brain circuits in newly diagnosed middle-aged type 2 diabetics.

Type 2 diabetes mellitus (T2DM) is well known for its adverse impacts on brain and cognition, which leads to multidimensional cognitive deficits and wildly spread cerebral structure abnormalities. However, existing literatures are mainly focused on patients with advanced age or extended T2DM duration. Therefore, it remains unclear whether and how brain function would be affected at the initial onset stage of T2DM in relatively younger population. In current study, twelve newly diagnosed middle-aged T2DM patients with no previous diabetic treatment history and twelve matched controls were recruited. Brain activations during a working memory task, the digit n-back paradigm (0-, 1- and 2-back), were obtained with functional magnetic resonance imaging and tested by repeated measures ANOVA. Whereas patients performed the n-back task comparably well as controls, significant load-by-group interactions of brain activation were found in the right dorsolateral prefrontal cortex (DLPFC), left middle/inferior frontal gyrus, and left parietal cortex, where patients exhibited hyperactivation in the 2-back, but not the 0-back or 1-back condition compared to controls. Furthermore, the severity of chronic hyperglycemia, estimated by glycosylated hemoglobin (HbA1c) level, was entered into partial correlational analyses with task-related brain activations, while controlling for the real-time influence of glucose, estimated by instant plasma glucose level measured before scanning. Significant positive correlations were found between HbA1c and brain activations in the anterior cingulate cortex and bilateral DLPFC only in patients. Taken together, these findings suggest there might be a compensatory mechanism due to brain inefficiency related to chronic hyperglycemia at the initial onset stage of T2DM.

8주 유산소 트레이닝이 중년의 제 2형 당뇨(T2DM)환자의 혈청지질 및 신장기능에 미치는 영향

본 연구의 목적은 8주 유산소 트레이닝이 제 2형 당뇨(T2DM)환자의 콜레스테롤과 신장기능에 미치는 영향을 규명하기 위함이다. 피험자는 총 4명(남 3, 여 1)이며 8주 유산소 걷기 트레이닝의 운동강도는 최대심박수(<TEX>$HR_{max}$</TEX>)의 60~75%, 주당 3~5 회, 20~45 분간 실시되었으며 다음과 같은 결과를 얻었다. 신체적 특성 중 체지방률과 공복시 혈당은 8주 유산소 걷기 트레이닝 후 유의하게(<TEX>$p$</TEX> <0.05) 감소함을 나타냈고, 혈중지질인 총 콜레스테롤(TC)과 중성지방(TG)도 유의한 감소를 나타냈다. 그러나 신장기능[BUN, uric acids, creatinine]은 유의한 변화를 나타내지 못했다. 결과적으로 8주 유산소 트레이닝은 제 2형 당뇨(T2DM)와 당뇨병성 신증 환자의 1예에서 체지방률과 공복시혈당, 지질을 감소시키는데 영향을 미쳤지만 신장기능 증진에는 어떠한 영향도 미치지 못했다. The purpose of this study was to examine the effect of 8 weeks of aerobic exercise on serum lipids and kidney function in middle-aged T2DM patients. Subjects participated in aerobic exercise training during 8 wk. They started with an exercise intensity of <TEX>$HR_{max}$</TEX> 60-75%, 20~45 minutes per day, 3~5 times a week. The results were compared to the baseline after 8 weeks. After the 8-week aerobic exercise routine, the body fat percentage and fasting glucose were significantly decreased, and the total cholesterol (TC) andtriglycerides (TG) were significantly decreased. Additionally, kidney function (Blood Urea Nitrogen (BUN], uric acids, and creatinine) was not significantly changed. In conclusion, a regular 8-week aerobic exercise training routine may improve serum lipids; however, kidney function (BUN, uric acids, and creatinine) did not change in middle-age type 2 diabetes mellitus (T2DM) and T2DM in diabetic nephropathy patients.