Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Nat Rev Endocrinol. 2011 Feb;7(2):108-14. doi: 10.1038/nrendo.2010.228.
Increasing numbers of people are developing type 2 diabetes mellitus, but interventions to prevent and treat the classic microvascular and macrovascular complications have improved, so that people are living longer with the condition. This trend means that novel complications of type 2 diabetes mellitus, which are not targeted by current management strategies, could start to emerge. Cognitive impairment and dementia could come into this category. Type 2 diabetes mellitus is associated with a 1.5-2.5-fold increased risk of dementia. The etiology of dementia and cognitive impairment in people with type 2 diabetes mellitus is probably multifactorial. Chronic hyperglycemia is implicated, perhaps by promoting the development of cerebral microvascular disease. Data suggest that the brains of older people with type 2 diabetes mellitus might be vulnerable to the effects of recurrent, severe hypoglycemia. Other possible moderators of cognitive function include inflammatory mediators, rheological factors and dysregulation of the hypothalamic-pituitary-adrenal axis. Cognitive function should now be included as a standard end point in randomized trials of therapeutic interventions in patients with type 2 diabetes mellitus.
越来越多的人患有 2 型糖尿病，但预防和治疗经典微血管和大血管并发症的干预措施已经得到改善，因此人们能够在这种情况下生存更长时间。这种趋势意味着 2 型糖尿病的新并发症可能开始出现，而这些并发症目前的管理策略并未针对。认知障碍和痴呆可能属于这一类。2 型糖尿病使痴呆的风险增加 1.5-2.5 倍。2 型糖尿病患者痴呆和认知障碍的病因可能是多因素的。慢性高血糖可能起作用，可能通过促进脑微血管疾病的发展。数据表明，年龄较大的 2 型糖尿病患者的大脑可能容易受到反复严重低血糖的影响。其他可能影响认知功能的因素包括炎症介质、流变学因素和下丘脑-垂体-肾上腺轴失调。认知功能现在应该作为 2 型糖尿病患者治疗干预随机试验的标准终点之一。
