Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
BMJ Open Diabetes Res Care. 2020 Jun;8(1). doi: 10.1136/bmjdrc-2020-001173.
Diabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy in T1D, understanding the role of DKA on brain health in older adults is crucial.
We examined the association of DKA with cognitive function in 714 older adults with T1D from the Study of Longevity in Diabetes. Participants self-reported lifetime exposure to DKA resulting in hospitalization; DKA was categorized into 0 hospitalization, 1 hospitalization or ≥2 hospitalizations (recurrent DKA). Global and domain-specific cognition (language, executive function/psychomotor speed, episodic memory and simple attention) were assessed. The association of DKA with cognitive function was evaluated via linear and logistic regression models.
Twenty-eight percent of participants (mean age=67 years; mean age at diagnosis=28 years; average duration of diabetes=39 years) reported a lifetime history of DKA resulting in hospitalization (18.5% single DKA; 9.7% recurrent DKA). In fully adjusted models, those with recurrent DKA had lower global cognitive function (β=-0.13; 95% CI -0.22 to 0.02) and lower scores on the executive function/psychomotor speed domain (β=-0.34; 95% CI -0.51 to 0.17). Individuals with recurrent DKA were also more likely to have the lowest level of cognitive function on the executive function/psychomotor speed domain (defined as 1.5 SD below the population mean; OR=3.26, 95% CI 1.43 to 7.42).
Among 714 older adults with T1D, recurrent DKA was associated with lower global cognitive function, lower scores on the executive function/psychomotor speed domain and 3.3 times greater risk of having the lowest level of cognitive function in our sample on the executive function/psychomotor speed domain. These findings suggest that recurrent DKA may negatively impact the brain health of older patients with T1D and highlight the importance of DKA prevention.
糖尿病酮症酸中毒（DKA）是糖尿病的一种严重并发症。DKA 与 1 型糖尿病（T1D）儿童的认知能力较差有关，但 T1D 老年患者是否存在这种情况尚不清楚。鉴于 T1D 的预期寿命不断延长，了解 DKA 对老年患者大脑健康的影响至关重要。
我们检查了 714 名来自糖尿病长寿研究的老年 T1D 患者中 DKA 与认知功能之间的关联。参与者自我报告一生中因 DKA 住院的情况；DKA 分为 0 次住院、1 次住院或≥2 次住院（复发性 DKA）。评估了全球和特定领域的认知功能（语言、执行功能/心理运动速度、情景记忆和简单注意力）。通过线性和逻辑回归模型评估 DKA 与认知功能的关系。
28%的参与者（平均年龄 67 岁；诊断时的平均年龄为 28 岁；糖尿病的平均病程为 39 年）报告一生中因 DKA 住院的病史（18.5%为单次 DKA；9.7%为复发性 DKA）。在完全调整的模型中，复发性 DKA 患者的整体认知功能较低（β=-0.13；95%CI-0.22 至 0.02），执行功能/心理运动速度领域的评分较低（β=-0.34；95%CI-0.51 至 0.17）。复发性 DKA 患者在执行功能/心理运动速度领域也更有可能处于认知功能最低水平（定义为低于人群平均水平 1.5 个标准差；OR=3.26，95%CI 1.43 至 7.42）。
在 714 名老年 T1D 患者中，复发性 DKA 与整体认知功能较低、执行功能/心理运动速度领域的评分较低以及在我们的样本中执行功能/心理运动速度领域认知功能最低水平的风险增加 3.3 倍有关。这些发现表明，复发性 DKA 可能对 T1D 老年患者的大脑健康产生负面影响，并强调了预防 DKA 的重要性。
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