Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C ; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C ; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C ; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Environment-Omics-Disease Research Centre, China Medical University Hospital, Taichung, Taiwan, R.O.C ; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, R.O.C.
PLoS One. 2014 Jan 29;9(1):e87095. doi: 10.1371/journal.pone.0087095. eCollection 2014.
Possible association between diabetes mellitus (DM) and Alzheimer's disease (AD) has been controversial. This study used a nationwide population-based dataset to investigate the relationship between DM and subsequent AD incidence.
Data were collected from Taiwan's National Health Insurance Research Database, which released a cohort dataset of 1,000,000 randomly sampled people and confirmed it to be representative of the Taiwanese population. We identified 71,433 patients newly diagnosed with diabetes (age 58.74 ± 14.02 years) since January 1997. Using propensity score, we matched them with 71,311 non-diabetic subjects by time of enrollment, age, gender, hypertension, hyperlipidemia, and previous stroke history. All the patients were followed up to December 31, 2007. The endpoint of the study was occurrence of AD.
Over a maximum 11 years of follow-up, diabetic patients experienced a higher incidence of AD than non-diabetic subjects (0.48% vs. 0.37%, p<0.001). After Cox proportional hazard regression model analysis, DM (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.50-2.07, p<0.001), age (HR, 1.11; 95% CI, 1.10-1.12, p<0.001), female gender (HR, 1.24; 95% CI, 1.06-1.46, p=0.008), hypertension (HR, 1.30; 95% CI, 1.07-1.59, p=0.01), previous stroke history (HR, 1.79; 95% CI, 1.28-2.50, p<0.001), and urbanization status (metropolis, HR, 1.32; 95% CI, 1.07-1.63, p=0.009) were independently associated with the increased risk of AD. Neither monotherapy nor combination therapy with oral antidiabetic medications were associated with the risk of AD after adjusting for underlying risk factors and the duration of DM since diagnosis. However, combination therapy with insulin was found to be associated with greater risk of AD (HR, 2.17; 95% CI, 1.04-4.52, p=0.039).
Newly diagnosed DM was associated with increased risk of AD. Use of hypoglycemic agents did not ameliorate the risk.
糖尿病（DM）与阿尔茨海默病（AD）之间可能存在关联，这一直存在争议。本研究使用全国性基于人群的数据集，调查 DM 与随后 AD 发病率之间的关系。
数据来自台湾全民健康保险研究数据库，该数据库发布了一个由 100 万人随机抽样组成的队列数据集，并证实该数据集能代表台湾人群。我们确定了自 1997 年 1 月以来新诊断为糖尿病（年龄 58.74 ± 14.02 岁）的 71433 例患者。通过倾向评分，我们按入组时间、年龄、性别、高血压、高血脂和既往卒中史，与 71311 名非糖尿病患者进行匹配。所有患者的随访时间截止至 2007 年 12 月 31 日。研究的终点为 AD 的发生。
在最长 11 年的随访中，糖尿病患者 AD 的发病率高于非糖尿病患者（0.48%比 0.37%，p<0.001）。经过 Cox 比例风险回归模型分析，DM（风险比 [HR]，1.76；95%置信区间 [CI]，1.50-2.07，p<0.001）、年龄（HR，1.11；95% CI，1.10-1.12，p<0.001）、女性性别（HR，1.24；95% CI，1.06-1.46，p=0.008）、高血压（HR，1.30；95% CI，1.07-1.59，p=0.01）、既往卒中史（HR，1.79；95% CI，1.28-2.50，p<0.001）和城市化状态（大都市，HR，1.32；95% CI，1.07-1.63，p=0.009）与 AD 风险增加独立相关。无论使用单药治疗还是联合使用口服降糖药物，在调整潜在风险因素和糖尿病诊断后时间后，与 AD 风险无关。然而，联合使用胰岛素与 AD 风险增加相关（HR，2.17；95% CI，1.04-4.52，p=0.039）。
新诊断的 DM 与 AD 风险增加相关。使用降血糖药物不能降低风险。
