Secnik Juraj, Cermakova Pavla, Fereshtehnejad Seyed-Mohammad, Dannberg Pontus, Johnell Kristina, Fastbom Johan, Winblad Bengt, Eriksdotter Maria, Religa Dorota
Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Diabetes Care. 2017 Sep;40(9):1159-1166. doi: 10.2337/dc16-2516. Epub 2017 Jun 27.
We aimed to investigate the differences in clinical characteristics and pharmacological treatment associated with the presence of diabetes in a large cohort of patients with dementia.
A cross-sectional registry-based study was conducted using data from the Swedish Dementia Registry (SveDem). Data on dementia diagnosis, dementia type, and demographic determinants were extracted from SveDem. Data from the Swedish Patient Register and Prescribed Drug Register were combined for the diagnosis of diabetes. Data on antidiabetic, dementia, cardiovascular, and psychotropic medications were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to determine whether the variables were associated with diabetes after adjustment for confounders. In total, 29,630 patients were included in the study, and 4,881 (16.5%) of them received a diagnosis of diabetes.
In the fully adjusted model, diabetes was associated with lower age at dementia diagnosis (odds ratio [OR] 0.97 [99% CI 0.97-0.98]), male sex (1.41 [1.27-1.55]), vascular dementia (1.17 [1.01-1.36]), and mixed dementia (1.21 [1.06-1.39]). Dementia with Lewy bodies (0.64 [0.44-0.94]), Parkinson disease dementia (0.46 [0.28-0.75]), and treatment with antidepressants (0.85 [0.77-0.95]) were less common among patients with diabetes. Patients with diabetes who had Alzheimer disease obtained significantly less treatment with cholinesterase inhibitors (0.78 [0.63-0.95]) and memantine (0.68 [0.54-0.85]).
Patients with diabetes were younger at dementia diagnosis and obtained less dementia medication for Alzheimer disease, suggesting less optimal dementia treatment. Future research should evaluate survival and differences in metabolic profile in patients with diabetes and different dementia disorders.
我们旨在调查一大群痴呆患者中与糖尿病存在相关的临床特征和药物治疗差异。
使用瑞典痴呆症登记处（SveDem）的数据进行了一项基于登记处的横断面研究。从SveDem中提取痴呆症诊断、痴呆症类型和人口统计学决定因素的数据。将瑞典患者登记处和处方药登记处的数据合并用于糖尿病诊断。从瑞典处方药登记处提取抗糖尿病、痴呆、心血管和精神药物的数据。在对混杂因素进行调整后，使用逻辑回归来确定变量是否与糖尿病相关。该研究共纳入29630名患者，其中4881名（16.5%）被诊断患有糖尿病。
在完全调整模型中，糖尿病与痴呆症诊断时年龄较小（优势比[OR]0.97[99%CI 0.97 - 0.98]）、男性（1.41[1.27 - 1.55]）、血管性痴呆（1.17[1.01 - 1.36]）和混合性痴呆（1.21[1.06 - 1.39]）相关。路易体痴呆（0.64[0.44 - 0.94]）、帕金森病痴呆（0.46[0.28 - 0.75]）以及使用抗抑郁药治疗（0.85[0.77 - 0.95]）在糖尿病患者中较少见。患有阿尔茨海默病的糖尿病患者接受胆碱酯酶抑制剂治疗（0.78[0.63 - 0.95]）和美金刚治疗（0.68[0.54 - 0.85]）的比例明显较低。
糖尿病患者痴呆症诊断时年龄较小，且阿尔茨海默病患者获得的痴呆症药物治疗较少，这表明痴呆症治疗不太理想。未来的研究应评估糖尿病患者和不同痴呆症患者的生存率及代谢谱差异。
