Department of Medicine, University of Toronto, Toronto, Canada.
Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada.
Diabetes Care. 2015 Oct;38(10):1868-75. doi: 10.2337/dc15-0491. Epub 2015 Jul 27.
To study whether diabetes onset in late life is a risk factor for dementia.
We conducted a population-based matched cohort study using provincial health data from Ontario, Canada. Seniors with (n = 225,045) and without newly diagnosed diabetes (n = 668,070) between April 1995 and March 2007 were followed until March 2012 for a new diagnosis of dementia. Cox proportional hazards modeling was used to compare the risk of dementia between groups after adjusting for baseline cardiovascular disease, chronic kidney disease (CKD), hypertension, and other risk factors.
Over this period, we observed 169,114 new cases of dementia. Individuals with diabetes had a modestly higher incidence of dementia (2.68 vs. 2.62 per 100 person-years) than those without diabetes. In the fully adjusted Cox model, the risk of dementia was 16% higher among our subgroup with diabetes (hazard ratio [HR] 1.16 [95% CI 1.15-1.18]). Adjusted HRs for dementia were 1.20 (95% CI 1.17-1.22) and 1.14 (95% CI 1.12-1.16) among men and women, respectively. Among seniors with diabetes, the risk of dementia was greatest in those with prior cerebrovascular disease (HR 2.03; 95% CI 1.88-2.19), peripheral vascular disease (HR 1.47; 95% CI 1.19-1.82), and CKD (HR 1.44; 95% CI 1.38-1.51), and those with one or more hospital visits for hypoglycemia (HR 1.73; 95% CI 1.62-1.84).
In this population-based study, newly diagnosed diabetes was associated with a 16% increase in the risk of dementia among seniors. Preexisting vascular disease and severe hypoglycemia were the greatest risk factors for dementia in seniors with diabetes.
研究晚年发生的糖尿病是否是痴呆的危险因素。
我们利用加拿大安大略省的省级健康数据开展了一项基于人群的匹配队列研究。1995 年 4 月至 2007 年 3 月期间，225045 名（n=225045）和 668070 名（n=668070）无新诊断糖尿病的老年人被纳入研究，随访至 2012 年 3 月，以记录新诊断的痴呆病例。采用 Cox 比例风险模型，在调整基线心血管疾病、慢性肾脏病（CKD）、高血压和其他危险因素后，比较两组之间痴呆的风险。
在此期间，我们观察到 169114 例新诊断的痴呆病例。与无糖尿病的个体相比，糖尿病患者的痴呆发病率略高（每 100 人年 2.68 例 vs. 2.62 例）。在完全调整的 Cox 模型中，我们的糖尿病亚组痴呆风险增加 16%（风险比 [HR] 1.16 [95%CI 1.15-1.18]）。男性和女性的调整后痴呆 HR 分别为 1.20（95%CI 1.17-1.22）和 1.14（95%CI 1.12-1.16）。在患有糖尿病的老年人中，患有既往脑血管疾病（HR 2.03；95%CI 1.88-2.19）、外周血管疾病（HR 1.47；95%CI 1.19-1.82）和 CKD（HR 1.44；95%CI 1.38-1.51）的患者，以及因低血糖住院治疗 1 次或以上的患者（HR 1.73；95%CI 1.62-1.84）痴呆风险最高。
在这项基于人群的研究中，新发糖尿病与老年人痴呆风险增加 16%相关。既往血管疾病和严重低血糖是糖尿病老年人痴呆的最大危险因素。
