Ye Fang, Luo Yong-Jie, Xiao Jun, Yu Neng-Wei, Yi Gang
Department of Neurology, Sichuan Provincial Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
Dement Geriatr Cogn Disord. 2016;41(5-6):251-60. doi: 10.1159/000445941. Epub 2016 Jun 2.
Abundant evidence from epidemiological and clinical studies has proven that diabetes mellitus (DM) is correlated with an increased incidence of dementia and Alzheimer's disease (AD). Insulin resistance is considered to play an important role in the associations between DM and dementia. However, whether insulin sensitizer drugs are effective in preventing dementia still remains unclear.
Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies that reported about the associations between insulin sensitizers and the incidence of dementia. The included studies were reviewed, and a meta-analysis was performed using STATA to determine the combined relative risk (RR) for the incidence of dementia when using insulin sensitizers. Subgroup analysis and meta regression were also conducted.
In total, nine comparisons out of six studies were qualified for inclusion, and data from 544,093 participants were evaluated. The results of the meta-analysis revealed a combined RR of 0.78 (95% CI 0.64-0.95, p = 0.015) for the incidence of dementia when using insulin sensitizers. The incidence rate of dementia was reduced with either metformin (RR 0.79, 95% CI 0.62-1.01, p = 0.064) or thiazolidinediones (RR 0.75, 95% CI 0.56-1.00, p = 0.050), both with a marginal trend toward significance.
The results indicate that insulin sensitizer drugs might provide protection against incident dementia. Controlled studies with large samples should be conducted to further confirm these conclusions and provide information for clinical strategies.
流行病学和临床研究的大量证据已证明，糖尿病（DM）与痴呆症和阿尔茨海默病（AD）发病率的增加相关。胰岛素抵抗被认为在DM与痴呆症的关联中起重要作用。然而，胰岛素增敏剂药物在预防痴呆症方面是否有效仍不清楚。
对PubMed、EMBASE、谷歌学术和ISI科学网进行电子检索，以识别报告胰岛素增敏剂与痴呆症发病率之间关联的研究。对纳入的研究进行综述，并使用STATA进行荟萃分析，以确定使用胰岛素增敏剂时痴呆症发病率的综合相对风险（RR）。还进行了亚组分析和荟萃回归。
总共六项研究中的九项比较符合纳入标准，对544,093名参与者的数据进行了评估。荟萃分析结果显示，使用胰岛素增敏剂时痴呆症发病率的综合RR为0.78（95%CI 0.64 - 0.95，p = 0.015）。使用二甲双胍（RR 0.79，95%CI 0.62 - 1.01，p = 0.064）或噻唑烷二酮类药物（RR 0.75，95%CI 0.56 - 1.00，p = 0.050）时，痴呆症发病率均有所降低，两者均有边缘性显著趋势。
结果表明，胰岛素增敏剂药物可能对新发痴呆症具有保护作用。应进行大样本对照研究以进一步证实这些结论，并为临床策略提供信息。
