Department of Medicine, University of Washington, Seattle, WA, USA.
N Engl J Med. 2013 Aug 8;369(6):540-8. doi: 10.1056/NEJMoa1215740.
Diabetes is a risk factor for dementia. It is unknown whether higher glucose levels increase the risk of dementia in people without diabetes.
We used 35,264 clinical measurements of glucose levels and 10,208 measurements of glycated hemoglobin levels from 2067 participants without dementia to examine the relationship between glucose levels and the risk of dementia. Participants were from the Adult Changes in Thought study and included 839 men and 1228 women whose mean age at baseline was 76 years; 232 participants had diabetes, and 1835 did not. We fit Cox regression models, stratified according to diabetes status and adjusted for age, sex, study cohort, educational level, level of exercise, blood pressure, and status with respect to coronary and cerebrovascular diseases, atrial fibrillation, smoking, and treatment for hypertension.
During a median follow-up of 6.8 years, dementia developed in 524 participants (74 with diabetes and 450 without). Among participants without diabetes, higher average glucose levels within the preceding 5 years were related to an increased risk of dementia (P=0.01); with a glucose level of 115 mg per deciliter (6.4 mmol per liter) as compared with 100 mg per deciliter (5.5 mmol per liter), the adjusted hazard ratio for dementia was 1.18 (95% confidence interval [CI], 1.04 to 1.33). Among participants with diabetes, higher average glucose levels were also related to an increased risk of dementia (P=0.002); with a glucose level of 190 mg per deciliter (10.5 mmol per liter) as compared with 160 mg per deciliter (8.9 mmol per liter), the adjusted hazard ratio was 1.40 (95% CI, 1.12 to 1.76).
Our results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes. (Funded by the National Institutes of Health.)
糖尿病是痴呆的一个风险因素。目前尚不清楚血糖水平升高是否会增加无糖尿病人群患痴呆的风险。
我们利用来自 2067 名无痴呆症参与者的 35264 次血糖水平临床测量值和 10208 次糖化血红蛋白水平测量值，研究了血糖水平与痴呆风险之间的关系。参与者来自成人思维变化研究，包括 839 名男性和 1228 名女性，基线时的平均年龄为 76 岁；232 名参与者患有糖尿病，1835 名参与者未患有糖尿病。我们根据糖尿病状态对 Cox 回归模型进行分层，并根据年龄、性别、研究队列、教育水平、运动水平、血压以及冠状动脉和脑血管疾病、心房颤动、吸烟和高血压治疗情况进行了调整。
在中位随访 6.8 年期间，524 名参与者（74 名患有糖尿病，450 名未患有糖尿病）发生了痴呆。在无糖尿病的参与者中，过去 5 年内较高的平均血糖水平与痴呆风险增加相关（P=0.01）；与血糖水平为 115mg/dL（6.4mmol/L）相比，血糖水平为 100mg/dL（5.5mmol/L）时，痴呆的调整后危险比为 1.18（95%置信区间[CI]，1.04 至 1.33）。在患有糖尿病的参与者中，较高的平均血糖水平也与痴呆风险增加相关（P=0.002）；与血糖水平为 190mg/dL（10.5mmol/L）相比，血糖水平为 160mg/dL（8.9mmol/L）时，调整后的危险比为 1.40（95%CI，1.12 至 1.76）。
我们的研究结果表明，即使在无糖尿病的人群中，较高的血糖水平也可能是痴呆的一个危险因素。（由美国国立卫生研究院资助）
