Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
Centre for Health Management and Policy Research, School of Public Health, , Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Biol Sex Differ. 2023 Feb 20;14(1):9. doi: 10.1186/s13293-023-00491-1.
Whether the association of type 2 diabetes (T2DM) with dementia was differed by sex remains unclear, and the roles of age at onset of disease, insulin use and diabetes' complications in their association are unknown.
This study analyzed data of 447 931 participants from the UK Biobank. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between T2DM and incident dementia [all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD)]. The roles of age at onset of disease, insulin use and diabetes' complications in their association were also analyzed.
Compared to people with no diabetes at all, people with T2DM had increased risk of all-cause dementia (HR 2.85, 95% CI 2.56-3.17). The HRs between T2DM and AD were higher in women than men, with an RHR (95%CI) of 1.56 (1.20, 2.02). There was a trend that people who experienced T2DM before age 55 had higher risk of VD than those who had T2DM after age 55. In addition, there was a trend that T2DM had higher effect on VD that occurred before age 75 years than events that occurred after age 75. Patients with T2DM using insulin had higher risk of all-cause dementia than those without insulin, with an RHR (95%CI) of 1.54 (1.00-2.37). People with complications had doubled risk of all-cause dementia, AD and VD.
Adopting a sex-sensitive strategy to address the risk of dementia in patients with T2DM is instrumental for a precision medicine approach. Meanwhile, it is warranted to consider patients' age at onset of T2DM, insulin use status and complications conditions.
2 型糖尿病（T2DM）与痴呆的相关性是否因性别而异尚不清楚，疾病发病年龄、胰岛素使用和糖尿病并发症在其相关性中的作用也不清楚。
本研究分析了英国生物库 447931 名参与者的数据。我们使用 Cox 比例风险模型估计 T2DM 与新发痴呆（包括所有原因痴呆、阿尔茨海默病[AD]和血管性痴呆[VD]）之间的性别特异性风险比（HR）和 95%置信区间（CI）以及女性与男性 HR 之比（RHR）。还分析了疾病发病年龄、胰岛素使用和糖尿病并发症在其相关性中的作用。
与无糖尿病者相比，T2DM 者发生所有原因痴呆的风险增加（HR 2.85，95%CI 2.56-3.17）。T2DM 与 AD 之间的 HR 在女性中高于男性，RHR（95%CI）为 1.56（1.20，2.02）。有趋势表明，55 岁前发生 T2DM 的人患 VD 的风险高于 55 岁后发生 T2DM 的人。此外，有趋势表明，T2DM 对 75 岁前发生的 VD 的影响高于对 75 岁后发生的 VD 的影响。使用胰岛素的 T2DM 患者发生所有原因痴呆的风险高于未使用胰岛素的患者，RHR（95%CI）为 1.54（1.00-2.37）。有并发症的患者发生所有原因痴呆、AD 和 VD 的风险增加了一倍。
采用一种性别敏感的策略来解决 T2DM 患者的痴呆风险，对于精准医疗方法来说是至关重要的。同时，有必要考虑患者 T2DM 的发病年龄、胰岛素使用状况和并发症情况。
