1 型糖尿病、2 型糖尿病与无糖尿病老年患者认知功能比较：来自糖尿病长寿研究（SOLID）的结果。
Comparison of cognitive function in older adults with type 1 diabetes, type 2 diabetes, and no diabetes: results from the Study of Longevity in Diabetes (SOLID).
机构信息
Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
Division of Research, Kaiser Permanente, Oakland, California, USA.
出版信息
BMJ Open Diabetes Res Care. 2022 Mar;10(2). doi: 10.1136/bmjdrc-2021-002557.
INTRODUCTION
The incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing. Life expectancy is improving in T1D, resulting in a growing population of elderly adults with diabetes. While it is well established that older adults with T2D are at increased risk of cognitive impairment, little is known regarding cognitive aging in T1D and how their cognitive profiles may differ from T2D.
RESEARCH DESIGN AND METHODS
We compared baseline cognitive function and low cognitive function by diabetes status (n=734 T1D, n=232 T2D, n=247 without diabetes) among individuals from the Study of Longevity in Diabetes (mean age=68). We used factor analysis to group cognition into five domains and a composite measure of total cognition. Using linear and logistic regression models, we examined the associations between diabetes type and cognitive function, adjusting for demographics, comorbidities, depression, and sleep quality.
RESULTS
T1D was associated with lower scores on total cognition, language, executive function/psychomotor processing speed, and verbal episodic memory, and greater odds of low executive function/psychomotor processing speed (OR=2.99, 95% CI 1.66 to 5.37) and verbal episodic memory (OR=1.92, 95% CI 1.07 to 3.46), compared with those without diabetes. T2D was associated with lower scores on visual episodic memory. Compared with T2D, T1D was associated with lower scores on verbal episodic memory and executive function/psychomotor processing speed and greater odds of low executive function/psychomotor processing speed (OR=1.74, 95% CI 1.03 to 2.92).
CONCLUSIONS
Older adults with T1D had significantly poorer cognition compared with those with T2D and those without diabetes even after accounting for a range of comorbidities. Future studies should delineate how to reduce risk in this vulnerable population who are newly surviving to old age.
简介
1 型糖尿病（T1D）和 2 型糖尿病（T2D）的发病率都在上升。T1D 的预期寿命正在提高，导致患有糖尿病的老年人口不断增加。虽然已经确定 2 型糖尿病患者认知功能受损的风险增加，但对于 T1D 患者的认知老化以及他们的认知特征如何与 T2D 不同知之甚少。
研究设计和方法
我们比较了来自糖尿病长寿研究（平均年龄=68 岁）的个体中按糖尿病状态（n=734 例 T1D、n=232 例 T2D、n=247 例无糖尿病）的基线认知功能和低认知功能。我们使用因子分析将认知分为五个领域和一个总体认知的综合测量值。我们使用线性和逻辑回归模型，在校正了人口统计学、合并症、抑郁和睡眠质量后，研究了糖尿病类型与认知功能之间的关系。
结果
与无糖尿病患者相比，T1D 与总认知、语言、执行功能/心理运动处理速度和言语情景记忆的得分较低以及执行功能/心理运动处理速度（OR=2.99，95%CI 1.66 至 5.37）和言语情景记忆（OR=1.92，95%CI 1.07 至 3.46）的低几率较高相关。T2D 与视觉情景记忆得分较低相关。与 T2D 相比，T1D 与言语情景记忆和执行功能/心理运动处理速度的得分较低以及执行功能/心理运动处理速度（OR=1.74，95%CI 1.03 至 2.92）的低几率较高相关。
结论
即使考虑到一系列合并症，与 T2D 和无糖尿病患者相比，T1D 老年患者的认知功能明显更差。未来的研究应该阐明如何降低这个新存活到老年的脆弱人群的风险。
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