Whitmer Rachel A, Gilsanz Paola, Quesenberry Charles P, Karter Andrew J, Lacy Mary E
From the Division of Epidemiology (R.A.W.), Public Health Sciences, University of California Davis School of Medicine; Division of Research (R.A.W., P.G., C.P.Q., A.J.K., M.E.L.), Kaiser Permanente, Oakland, CA; Department of Epidemiology (M.E.L.), University of Kentucky, Lexington; and Department of Epidemiology and Biostatistics (M.E.L.), University of California, San Francisco.
Neurology. 2021 Jul 19;97(3):e275-e283. doi: 10.1212/WNL.0000000000012243.
To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes.
A longitudinal cohort study followed up 2,821 members of an integrated health care delivery system with type 1 diabetes from 1997 to 2015. Hypoglycemic and hyperglycemic events requiring emergency room or hospitalization were abstracted from medical records beginning January 1, 1996, through cohort entry. Participants were followed up for dementia diagnosis through September 30, 2015. Dementia risk was examined with Cox proportional hazard models adjusted for age (as time scale), sex, race/ethnicity, hemoglobin A1c, depression, stroke, and nephropathy.
Among 2,821 older adults (mean age 56 years) with type 1 diabetes, 398 (14%) had a history of severe hypoglycemia, 335 (12%) had severe hyperglycemia, and 87 (3%) had both. Over a mean 6.9 years of follow-up, 153 individuals (5.4%) developed dementia. In fully adjusted models, individuals with hypoglycemic events had 66% greater risk of dementia than those without a hypoglycemic event (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.09, 2.53), while those with hyperglycemic events had >2 times the risk (HR 2.11, 95% CI 1.24, 3.59) than those without a hyperglycemic event. There was a 6-fold greater risk of dementia in individuals with both severe hypoglycemia and hyperglycemia vs those with neither (HR 6.20, 95% CI 3.02, 12.70).
For older individuals with type 1 diabetes, severe hypoglycemic and hyperglycemic events are associated with increased future risk of dementia.
确定严重低血糖和高血糖事件是否与1型糖尿病老年患者的痴呆症纵向发病风险相关。
一项纵向队列研究对1997年至2015年综合医疗保健系统中的2821名1型糖尿病患者进行了随访。从1996年1月1日至队列入组期间，从医疗记录中提取需要急诊或住院治疗的低血糖和高血糖事件。对参与者进行随访，直至2015年9月30日诊断出痴呆症。使用Cox比例风险模型对痴呆症风险进行分析，并对年龄（作为时间尺度）、性别、种族/民族、糖化血红蛋白、抑郁症、中风和肾病进行校正。
在2821名1型糖尿病老年患者（平均年龄56岁）中，398人（14%）有严重低血糖病史，335人（12%）有严重高血糖病史，87人（3%）两者都有。在平均6.9年的随访中，153人（5.4%）患上了痴呆症。在完全校正的模型中，发生过低血糖事件的个体患痴呆症的风险比未发生过低血糖事件的个体高66%（风险比[HR]1.66，95%置信区间[CI]1.09，2.53），而发生过高血糖事件的个体患痴呆症的风险是未发生过高血糖事件个体的2倍多（HR 2.11，95%CI 1.24，3.59）。与既无严重低血糖也无严重高血糖的个体相比，同时患有严重低血糖和高血糖的个体患痴呆症的风险高6倍（HR 6.20，95%CI 3.02，12.70）。
对于1型糖尿病老年患者，严重低血糖和高血糖事件与未来患痴呆症的风险增加相关。
