Cognitive Impairment, Type 2 Diabetes Mellitus
Conditions
Brief summary
The prevalence of cognitive dysfunction in diabetic patients is high, which seriously affects the quality of life of patients, and early intervention is of great significance. Central nervous system insulin resistance plays a key role in the pathogenesis of cognitive dysfunction in diabetic patients. Central insulin resistance observed by functional magnetic resonance imaging (fMRI), may serve as an alternative endpoint for assessing cognitive function. Sodium glucose cotransporter 2 inhibitor (SGLT2i) may improve cognitive impairment by improving central insulin resistance.
Detailed description
The prevalence of cognitive dysfunction in diabetic patients is high, which seriously affects the quality of life of patients. Cognitive impairment mainly includes two stages: mild cognitive impairment (MCI) and dementia. Early detection of diabetic patients with MCI and effective intervention measures to prevent and delay the onset of dementia have important clinical value and social significance. With the development of imaging technology, especially fMRI changes in local blood flow and metabolic activities of the brain can be displayed before changes in brain structure. The central insulin resistance status observed by fMRI may serve as an alternative endpoint for assessing cognitive function. SGLT2i has been shown to significantly improve insulin resistance in the central nervous system in previous basic and clinical studies. However, up to now, no head-to-head clinical studies have been reported on SGLT2i and other antidiabetic drugs in patients with MCI. Based on the above research background, we hypothesize that canagliflozin, as a clinically commonly used SGLT2i, it may improve cognitive function in patients with type 2 diabetes mellitus and MCI by improving insulin resistance in the central nervous system.
Interventions
DRUGCanagliflozin group
Canagliflozin,100mg once daily, orally, for 6 months
DRUGSitagliptin
Sitagliptin,100mg once daily, orally, for 6 months
DRUGAcarbose
Acarbose,100mg three times daily, orally, for 6 months
Sponsors
Fudan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* age: 40-75 years old; * HbA1c: 7.0 - 10.0%; * Moca scale total score between 20-26 (duration of education is more than 10 years) or total score between 20 and 25 (duration of education is less than 10 years); * sign informed consent;
Exclusion criteria
* left-handedness; * duration of diabetes is less than 6 years; * inability to complete central nervous system magnetic resonance imaging; * alcohol or drug addiction history; * use of other oral hypoglycemic drugs within 90 days prior to enrollment except for metformin; * Family or past history of neurological or psychiatric disorders, pancreatitis, medullary thyroid cancer and multiple endocrine adenomatosis; * History of recurrent urinary tract infection and malignant tumor; * History of severe gastrointestinal diseases and gastroenteric surgery; * Pregnancy/lactation status; * Abnormal liver function (liver enzyme index is more than 2.5 times the upper limit of the reference range) or abnormal kidney function (estimated glomerular filtration rate is less than 45ml/min); Type 1 diabetes; other diseases or conditions that reduce the possibility of enrollment or complicate enrollment, such as frequent changes in the working environment and unstable living environment, which are likely to cause loss of follow-up, according to the judgment of the researchers;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the changes in cerebral blood flow shown by fMRI | 6 months | the changes in cerebral blood flow shown by fMRI after nasal inhalation of insulin |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Montreal Cognitive Assessment Scale (Moca scale) | 6 months | The Moca scale score ranges from 0 to 30. The higher the score, the better the cognitive function. Scores ranging from 12 to 21 are classified as dementia, while scores between 19 and 26 are classified as MCI. The investigators compare the scores of the Moca scale before and after the intervention. |
| body composition | 6 months | The body composition is measured using Beijing Yueqi BIA. The indicators include weight (kg), skeletal muscle (kg), body fat (kg), body mass index (kg/m2), body fat percentage (%), visceral fat area (cm2), waist-to-hip ratio, and skeletal muscle index (kg/m2). The investigators compare the changes in body composition before and after the intervention. |
| grip strength | 6 months | The grip strength is evaluated using an electronic grip strength tester. Each hand is tested twice, and the average values are taken. The side with the greater grip strength is selected as the final grip strength. A low grip strength is defined as less than 28 kg for men and less than 18 kg for women. The investigators compare the changes in grip strength before and after the intervention. |
| glycated hemoglobin | 6 months | The glycated hemoglobin (%) is measured on an empty stomach, and the investigators compare the changes before and after the intervention. |
| insulin | 6 months | The measurement of insulin (mIU/L) is conducted in the fasting state. The investigators compare the changes before and after the intervention. |
| C-peptide | 6 months | The measurement of C-peptide (ng/ml) is conducted in the fasting state. The investigators compare the changes before and after the intervention. |
| blood glucose | 6 months | The measurement of blood glucose (mmol/L) is conducted in the fasting state. The investigators compare the changes before and after the intervention. |
Countries
China
Contacts
CONTACTBin Lu, doctor
CONTACTCuiping Jiang, master
Outcome results
None listed