Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Research Institute for Skin Image, Korea University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2022 Nov;46(6):923-935. doi: 10.4093/dmj.2021.0346. Epub 2022 May 24.
We investigated whether fasting glucose (FG) variability could predict the risk of dementia.
This cohort study analyzed data from Koreans with diabetes after at least three health examinations by the Korean National Health Insurance Corporation between 2005 and 2010, which included at least one examination between 2009 and 2010. A total of 769,554 individuals were included, excluding those aged <40 years and those with dementia. FG variability was measured using the variability independent of the mean (FG-VIM). The incidence of dementia was defined by the International Classification of Diseases 10th Revision codes and prescription of anti-dementia medication and was subdivided into Alzheimer's disease (AD) and vascular dementia (VD).
During the 6.9-year follow-up, 54,837, 41,032, and 6,892 cases of all-cause dementia, AD, and VD, respectively, were identified. Cox proportional regression analyses showed that as the FG-VIM quartile increased, the risk of dementia serially increased after adjustment for metabolic factors, income status, and diabetes-related characteristics, including the mean FG. Participants in FG-VIM quartile 4 showed a 18%, 19%, and 17% higher risk for all-cause dementia, AD, and VD, respectively, than those in quartile 1; this particularly included non-obese patients with a longer duration of diabetes, high FG levels, dyslipidemia, and those taking glucose-lowering medications. Conversely, the baseline FG status and dementia showed a U-shaped association.
Increased FG variability over 5 years can predict the risk of dementia in individuals with diabetes in Korea. This finding was more pronounced in patients with less favorable metabolic profiles.
我们研究了空腹血糖（FG）变异性是否可以预测痴呆风险。
本队列研究分析了韩国国民健康保险服务公司 2005 年至 2010 年期间至少进行了三次健康检查的糖尿病患者的数据，这些检查中至少有一次是在 2009 年至 2010 年之间进行的。共纳入 769554 人，排除年龄<40 岁和痴呆患者。使用均值无关的变异度（FG-VIM）测量 FG 变异性。痴呆的发病情况通过国际疾病分类第 10 次修订版代码和抗痴呆药物的处方来定义，并细分为阿尔茨海默病（AD）和血管性痴呆（VD）。
在 6.9 年的随访期间，分别确定了 54837、41032 和 6892 例全因痴呆、AD 和 VD。Cox 比例风险回归分析显示，在调整代谢因素、收入状况和与糖尿病相关的特征（包括平均 FG）后，随着 FG-VIM 四分位间距的增加，痴呆的风险呈连续增加。与四分位间距 1 相比，FG-VIM 四分位间距 4 的参与者发生全因痴呆、AD 和 VD 的风险分别高出 18%、19%和 17%；这尤其包括糖尿病病程较长、空腹血糖水平较高、血脂异常和服用降血糖药物的非肥胖患者。相反，基线 FG 水平与痴呆之间呈 U 型关联。
在韩国的糖尿病患者中，5 年内 FG 变异性的增加可以预测痴呆的风险。这一发现对于代谢特征较差的患者更为明显。
