The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Department of Neurology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Diabetologia. 2018 Sep;61(9):1913-1917. doi: 10.1007/s00125-018-4689-9. Epub 2018 Jul 12.
The association between type 2 diabetes and cognitive dysfunction is well established. Prevention of the development of type 2 diabetes and its complications, as well as cognitive dysfunction and dementia, are leading goals in these fields. Deciphering the causality direction of the interplay between type 2 diabetes and cognitive dysfunction, and understanding the timeline of disease progression, are crucial for developing efficient prevention strategies. The prevailing perception is that type 2 diabetes leads to cognitive dysfunction and dementia. There is substantial evidence showing that accelerated cognitive decline in type 2 diabetes starts in midlife (mean age 40-60 years) and that it may even begin at the prediabetes stage. However, in this issue of Diabetologia, Altschul et al (doi: https://doi.org/10.1007/s00125-018-4645-8 ) show evidence for the reverse causality hypothesis, i.e. that lower cognitive function precedes poor glycaemic control. They found that cognitive function at early adolescence (age 11 years) predicts both HbA levels and cognitive function at age 70 years. Moreover, they found that lower cognitive function at age 70 is associated with an increase in HbA from age 70 to 79 years. Based on these findings, future studies should explore whether developing prevention strategies that target young adolescents with lower cognitive function will result in prevention of type 2 diabetes, breaking the vicious cycle of type 2 diabetes and cognitive dysfunction.
2 型糖尿病与认知功能障碍之间的关联已得到充分证实。预防 2 型糖尿病及其并发症以及认知功能障碍和痴呆症的发生，是这些领域的主要目标。阐明 2 型糖尿病与认知功能障碍之间相互作用的因果关系方向，并了解疾病进展的时间线，对于制定有效的预防策略至关重要。目前的观点认为，2 型糖尿病会导致认知功能障碍和痴呆症。有大量证据表明，2 型糖尿病患者的认知能力衰退加速始于中年（平均年龄 40-60 岁），甚至可能在糖尿病前期就开始了。然而，在本期《糖尿病学》杂志上，Altschul 等人（doi: https://doi.org/10.1007/s00125-018-4645-8 ）提出了相反的因果关系假说，即较低的认知功能先于较差的血糖控制。他们发现，青少年早期（11 岁）的认知功能既可以预测 HbA 水平，也可以预测 70 岁时的认知功能。此外，他们发现，70 岁时较低的认知功能与 70 岁至 79 岁期间 HbA 的增加有关。基于这些发现，未来的研究应该探索针对认知功能较低的青少年制定预防策略是否会预防 2 型糖尿病，从而打破 2 型糖尿病和认知功能障碍之间的恶性循环。
