Ye Min, Yang Qiqi, Zhang Lele, Song Hudie, Fu Qin, Qian Jun, Xie Hongyu, Yuan Aihong
First School of Clinical Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China.
Acupuncture and Rehabilitation Department, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.
Front Neurol. 2024 Aug 13;15:1394499. doi: 10.3389/fneur.2024.1394499. eCollection 2024.
Type 2 diabetes mellitus (T2DM) is widely acknowledged as a vital warning sign contributing to cognitive dysfunction. However, there is still a lack of consensus on whether hypoglycemic events resulting from poor glycemic control increase the risk of cognitive dysfunction in people with diabetes, and the potential dose-response correlation between hypoglycemic events and cognitive dysfunction remains unexplored. The primary objective of the current study was to assess the contribution of hypoglycemic events to cognitive dysfunction in T2DM patients and the dose-response correlation between the two.
A comprehensive search of nine major databases was executed from inception to May 2023. We screened all observational studies examining the connection between hypoglycemia and cognitive dysfunction. The DerSimonian-Laird method was used to compute the combined risk ratio (RR) and its 95% confidence interval (CI). Additionally, dose-response analysis was employed to investigate the correlation between the frequency of hypoglycemia and the likelihood of cognitive dysfunction.
A total of 30 studies of different levels in 17 articles with 3,961,352 participants were included in this review. The pooled RR for the connection of hypoglycemia and the likelihood of cognitive dysfunction was 1.47 (95% CI: 1.35-1.60). Subgroup analyses showed that the pooled RR for the likelihood of cognitive dysfunction was 1.20 (95% CI: 1.11-1.31) for one episode of hypoglycemia, 1.41 (95% CI: 1.05-1.88) for two episodes of hypoglycemia, and 1.62 (95% CI: 1.20-2.91) for three or more episodes of hypoglycemia. Dose-response analysis showed a linear dose-response relationship between hypoglycemia and the likelihood of cognitive dysfunction (exp () = 1.178694, = 7.12, < 0.001).
Our investigations demonstrated a 47% heightened likelihood of cognitive dysfunction in individuals with hypoglycemia compared to those without. Furthermore, the likelihood of cognitive dysfunction climbed by 17.87% for every subsequent episode of hypoglycemia. Therefore, long-term monitoring of blood glucose, periodic screening of cognitive function, and moderate health education should be encouraged, which will be beneficial for people with diabetes to prevent hypoglycemic events and cognitive dysfunction.
https://www.crd.york.ac.uk/PROSPERO/, CRD42023432352.
2型糖尿病（T2DM）被广泛认为是导致认知功能障碍的一个重要警示信号。然而，对于血糖控制不佳导致的低血糖事件是否会增加糖尿病患者认知功能障碍的风险，目前仍缺乏共识，低血糖事件与认知功能障碍之间潜在的剂量反应关系也尚未得到探索。本研究的主要目的是评估低血糖事件对T2DM患者认知功能障碍的影响以及两者之间的剂量反应关系。
对9个主要数据库从建库至2023年5月进行了全面检索。我们筛选了所有研究低血糖与认知功能障碍之间关联的观察性研究。采用DerSimonian-Laird方法计算合并风险比（RR）及其95%置信区间（CI）。此外，采用剂量反应分析来研究低血糖发生频率与认知功能障碍可能性之间的相关性。
本综述共纳入17篇文章中的30项不同水平的研究，涉及3961352名参与者。低血糖与认知功能障碍可能性之间关联的合并RR为1.47（95%CI：1.35 - 1.60）。亚组分析显示，一次低血糖发作时认知功能障碍可能性的合并RR为1.20（95%CI：1.11 - 1.31），两次低血糖发作时为1.41（95%CI：1.05 - 1.88），三次及以上低血糖发作时为1.62（95%CI：1.20 - 2.91）。剂量反应分析显示低血糖与认知功能障碍可能性之间存在线性剂量反应关系（exp() = 1.178694， = 7.12， < 0.001）。
我们的研究表明，与未发生低血糖的个体相比，发生低血糖的个体认知功能障碍的可能性增加了47%。此外，每随后发生一次低血糖发作，认知功能障碍的可能性就会增加17.87%。因此，应鼓励对血糖进行长期监测、定期筛查认知功能并进行适度的健康教育，这将有助于糖尿病患者预防低血糖事件和认知功能障碍。
