Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
Diabetes Care. 2024 Sep 1;47(9):1576-1583. doi: 10.2337/dc24-0203.
The impact of age of diabetes diagnosis on dementia risk across the life course is poorly characterized. We estimated the lifetime risk of dementia by age of diabetes diagnosis.
We included 13,087 participants from the Atherosclerosis Risk in Communities Study who were free from dementia at age 60 years. We categorized participants as having middle age-onset diabetes (diagnosis <60 years), older-onset diabetes (diagnosis 60-69 years), or no diabetes. Incident dementia was ascertained via adjudication and active surveillance. We used the cumulative incidence function estimator to characterize the lifetime risk of dementia by age of diabetes diagnosis while accounting for the competing risk of mortality. We used restricted mean survival time to calculate years lived without and with dementia.
Among 13,087 participants, there were 2,982 individuals with dementia and 4,662 deaths without dementia during a median follow-up of 24.1 (percentile 25-percentile 75, 17.4-28.3) years. Individuals with middle age-onset diabetes had a significantly higher lifetime risk of dementia than those with older-onset diabetes (36.0% vs. 31.0%). Compared with those with no diabetes, participants with middle age-onset diabetes also had a higher cumulative incidence of dementia by age 80 years (16.1% vs. 9.4%) but a lower lifetime risk (36.0% vs. 45.6%) due to shorter survival. Individuals with middle age-onset diabetes developed dementia 4 and 1 years earlier than those without diabetes and those with older-onset diabetes, respectively.
Preventing or delaying diabetes may be an important approach for reducing dementia risk throughout the life course.
糖尿病诊断年龄对整个生命周期痴呆风险的影响尚不清楚。我们根据糖尿病诊断年龄估计痴呆的终生风险。
我们纳入了来自动脉粥样硬化风险社区研究的 13087 名参与者，他们在 60 岁时没有痴呆。我们将参与者分为中年发病型糖尿病（<60 岁诊断）、老年发病型糖尿病（60-69 岁诊断）或无糖尿病。通过裁判和主动监测确定痴呆的发病情况。我们使用累积发生率函数估计器来描述糖尿病诊断年龄对痴呆终生风险的影响，同时考虑了死亡的竞争风险。我们使用限制平均生存时间来计算无痴呆和有痴呆的生存年数。
在 13087 名参与者中，有 2982 人患有痴呆，4662 人在无痴呆的情况下死亡，中位随访时间为 24.1 年（25%分位数-75%分位数，17.4-28.3）。中年发病型糖尿病患者的痴呆终生风险明显高于老年发病型糖尿病患者（36.0%比 31.0%）。与无糖尿病的参与者相比，中年发病型糖尿病患者在 80 岁时的痴呆累积发生率也更高（16.1%比 9.4%），但终生风险更低（36.0%比 45.6%），原因是生存时间更短。与无糖尿病和老年发病型糖尿病患者相比，中年发病型糖尿病患者分别提前 4 年和 1 年发生痴呆。
预防或延迟糖尿病可能是降低整个生命周期痴呆风险的重要方法。
