Han Eugene, Han Kyung-do, Lee Byung-Wan, Kang Eun Seok, Cha Bong-Soo, Ko Seung-Hyun, Lee Yong-Ho
Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea.
J Clin Endocrinol Metab. 2022 Apr 19;107(5):e1976-e1986. doi: 10.1210/clinem/dgab860.
There are few studies focused on the relationship between hypoglycemia and new-onset dementia in patients with type 2 diabetes and no study regarding mortality of dementia after hypoglycemia.
We investigated the effect of severe hypoglycemia on dementia subtypes and its relation to overall mortality in patients with type 2 diabetes.
We evaluated incident dementia, including Alzheimer disease and vascular dementia, among health checkup participants aged 40 years or older in the National Health Insurance System in Korea from January 2009 to December 2015. Episodes of severe hypoglycemia were examined for 3 years before the date of the health checkup.
Among 2 032 689 participants (1 172 271 men, 860 418 women), 14 443 (0.7%) experienced severe hypoglycemia, during a mean follow-up period of 6.9 ± 1.7 years. Individuals in the severe hypoglycemia group were more likely to be diagnosed with dementia compared to individuals without severe hypoglycemia (23.3% vs 7.3%; P < .001) and the overall incidence of Alzheimer disease was higher than vascular dementia. Dementia risk rose with increasing number of severe hypoglycemic episodes (1 episode [hazard ratio (HR) = 1.54; 95% CI, 1.48-1.60], 2 or more episodes [HR = 1.80; 95% CI, 1.66-1.94]). Overall mortality was higher in participants with dementia, but without severe hypoglycemia (HR = 2.03; 95% CI, 1.96-2.10) and severe hypoglycemia, but without dementia (HR = 4.24; 95% CI, 4.29-4.40), and risk of death was highest in those with both severe hypoglycemia and dementia (HR = 5.08; 95% CI, 4.83-5.35).
Severe hypoglycemia is associated with dementia, especially Alzheimer disease and mortality; together, they have an additive effect on overall mortality.
很少有研究关注2型糖尿病患者低血糖与新发痴呆之间的关系，且尚无关于低血糖后痴呆死亡率的研究。
我们研究了严重低血糖对痴呆亚型的影响及其与2型糖尿病患者全因死亡率的关系。
我们评估了2009年1月至2015年12月在韩国国民健康保险系统中40岁及以上健康体检参与者的新发痴呆情况，包括阿尔茨海默病和血管性痴呆。在健康体检日期前3年检查严重低血糖发作情况。
在2032689名参与者（1172271名男性，860418名女性）中，平均随访6.9±1.7年，14443人（0.7%）经历了严重低血糖。与未发生严重低血糖的个体相比，严重低血糖组个体更易被诊断为痴呆（23.3%对7.3%；P<0.001），且阿尔茨海默病的总体发病率高于血管性痴呆。痴呆风险随严重低血糖发作次数增加而升高（1次发作[风险比（HR）=1.54；95%置信区间，1.48 - 1.60]，2次或更多次发作[HR = 1.80；95%置信区间，1.66 - 1.94]）。有痴呆但无严重低血糖的参与者全因死亡率较高（HR = 2.03；95%置信区间，1.96 - 2.10），有严重低血糖但无痴呆的参与者全因死亡率也较高（HR = 4.24；95%置信区间，4.29 - 4.40），而既有严重低血糖又有痴呆的参与者死亡风险最高（HR = 5.08；95%置信区间，4.83 - 5.35）。
严重低血糖与痴呆相关，尤其是阿尔茨海默病，且与死亡率相关；它们对全因死亡率具有叠加效应。
