2型糖尿病患者周围神经病变与痴呆的关联：一项使用国民健康保险服务-国家健康信息数据库的5年随访研究
Association of peripheral neuropathy with dementia in type 2 diabetes: a 5-year follow-up study using the national health insurance service-national health information database.
作者信息
Jin Heung Yong, Kim Ko Woon, Lee Kyung Ae, Park Tae Sun, Kim Min Ji, Kim Jong Seung
机构信息
Department of Internal Medicine, Division of Endocrinology and Metabolism, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
Department of Neurology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
出版信息
Endocrine. 2025 May 23. doi: 10.1007/s12020-025-04227-6.
OBJECTIVE
To investigate whether the incidence of dementia is associated with diabetic peripheral neuropathy (DPN) in type 2 diabetes.
METHODS
Using the National Health Insurance Service-National Health Information Database, we calculated the incidence of various types of dementia according to type 2 diabetes with or without DPN by applying multivariate Cox regression analysis. Propensity score matching was performed to equalize each group by considering demographic characteristics and underlying conditions.
RESULTS
The incidence of various types of dementia was higher in patients with type 2 diabetes than in those without diabetes. The risk of developing dementia was higher in type 2 diabetes with DPN than in type 2 diabetes without DPN, irrespective of dementia type (all dementia: 1.53 vs. 2.1 vs. 1.4, P < 0.05, Alzheimer's disease: 1.46 vs. 1.98 vs. 1.34, P < 0.05, vascular dementia: 1.86 vs. 2.75 vs. 1.66, P < 0.05, other dementia: 1.62 vs. 2.19 vs. 1.48, P < 0.05; all type 2 diabetes vs. type 2 diabetes with DPN vs. type 2 diabetes without DPN compared with non-diabetes). When sodium-glucose cotransporter-2 inhibitors (SGLT2Is) were used, the incidence of all dementia types was lower in patients with type 2 diabetes than in patients with type 2 diabetes who did not use SGLT2Is although the incidence showed more decreased trend when dipeptidyl peptidase IV inhibitor (DPPIVI) was combined (all dementia: 0.51-0.71, P < 0.05, Alzheimer's disease: 0.78-0.80, P < 0.05, vascular dementia: 0.28-0.35, P < 0.05, other dementia: 0.2-0.70, P < 0.05; SGLT2Is user vs. neither SGLT2I nor DPPIVI). This pattern was also observed in patients with type 2 diabetes and DPN (all dementia: 0.32-0.56, P < 0.05, Alzheimer's disease: 0.44-0.55, P < 0.05, vascular dementia: 0.33, P < 0.05, other dementia: 0.53, P < 0.05; SGLT2Is user vs. neither SGLT2I nor DPPIVI).
CONCLUSIONS
More active diagnostic and prevention efforts are needed to address the risk of developing all forms of dementia, including vascular dementia, in patients with diabetes and DPN.
目的
探讨2型糖尿病患者中痴呆的发病率是否与糖尿病周围神经病变（DPN）相关。
方法
利用国民健康保险服务-国民健康信息数据库，通过多变量Cox回归分析，我们计算了伴有或不伴有DPN的2型糖尿病患者中各类痴呆的发病率。通过倾向得分匹配，考虑人口统计学特征和基础疾病，使每组达到均衡。
结果
2型糖尿病患者中各类痴呆的发病率高于非糖尿病患者。伴有DPN的2型糖尿病患者发生痴呆的风险高于不伴有DPN的2型糖尿病患者，无论痴呆类型如何（所有痴呆：1.53对2.1对1.4，P<0.05；阿尔茨海默病：1.46对1.98对1.34，P<0.05；血管性痴呆：1.86对2.75对1.66，P<0.05；其他痴呆：1.62对2.19对1.48，P<0.05；所有2型糖尿病患者与伴有DPN的2型糖尿病患者与不伴有DPN的2型糖尿病患者与非糖尿病患者相比）。当使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2Is）时，2型糖尿病患者中所有痴呆类型的发病率低于未使用SGLT2Is的2型糖尿病患者，尽管当联合使用二肽基肽酶IV抑制剂（DPPIVI）时发病率下降趋势更明显（所有痴呆：0.51 - 0.71，P<0.05；阿尔茨海默病：0.78 - 0.80，P<0.05；血管性痴呆：0.28 - 0.35，P<0.05；其他痴呆：0.2 - 0.70，P<0.05；SGLT2Is使用者与既未使用SGLT2Is也未使用DPPIVI者）。在伴有DPN的2型糖尿病患者中也观察到这种模式（所有痴呆：0.32 - 0.56，P<0.05；阿尔茨海默病：0.44 - 0.55，P<0.05；血管性痴呆：0.33，P<0.05；其他痴呆：0.53，P<0.05；SGLT2Is使用者与既未使用SGLT2Is也未使用DPPIVI者）。
结论
对于糖尿病和DPN患者，需要更积极的诊断和预防措施来应对包括血管性痴呆在内的所有形式痴呆的发生风险。
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