THE USE OF INSULIN PUMP THERAPYIN DIABETES MELLITUS TYPE 1 AND ITS RELATION TO COGNITIVE PERFORMANCE, PSYCHOLOGICAL WELL-BEING AND BRAIN MRI

Background. Diabetes mellitus (DM) is a common metabolic disease.Although cognition in older patients with type 1 diabetes (DM1) appears to be only mildly disturbed compared to non-diabetic controls, it may be that specificsubgroups of DM1 patients, such as those with worse metabolic control,have a higher risk for cognitive decline. Patients with continuous subcutaneousinsulin infusion (CSII) differ from patients on a multiple daily injection(MDI) regime in several important metabolic parameters. The present observationalstudy therefore aimed to compare cognition, psychological wellbeingand brain MRI between older patients with DM1 with and without CSII.Material and methods. For this project we enrolled 40 patients with DM1(52-77 years, mean duration DM 34 years), of whom 19 were receiving CSII(mean duration: 6.5 3.5 years) and 21 were on MDI. Neuropsychologicalassessment covered five major cognitive domains. Psychological well-beingwas assessed by the Symptom Checklist (SCL)-90-R and the Beck DepressionInventory (BDI). Atrophy, white-matter abnormalities (WML) and infarctswere rated on MRI scans.Results. Patients with and without CSII did not differ on neuropsychologicalmeasures. Patients with CSII had significantly higher scores on the BDIIIand better MRI ratings on cortical atrophy measures, but not on the otherMRI measures.Conclusions. CSII seems to be associated with better MRI ratings, withoutbetter cognitive performance. It could be worthwhile to compare CSII withother treatment regimes in a longitudinal randomized controlled trial.