Flood David, Green Hunter, Gross Alden, Kobayashi Lindsay C, Levine Deborah A, Lee Jinkook, Wixom Caroline R, Langa Kenneth M
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Open. 2025 Jul 20;15(7):e074794. doi: 10.1136/bmjopen-2023-074794.
Most research on the relationship between diabetes and cognitive health has used data from high-income countries. This study described this relationship in India, the world's most populous country.
Cross-sectional analysis of the baseline wave of the nationally representative Longitudinal Ageing Study in India, conducted from 2017 to 2019.
All 36 Indian states and union territories.
57 905 adults aged 45 years or older.
Scaled cognitive scores (mean of 0 and SD of 1) and cognitive impairment defined as a cognitive score 1.5 SD or below the age-matched and education-matched mean. Diabetes was defined as a self-report of a prior diabetes diagnosis made by a health professional or having a measured haemoglobin A1c ≥6.5%.
In age-adjusted and sex-adjusted models, people with diabetes had cognitive scores that were 0.24 SD higher (95% CI 0.22 to 0.26) and had a 1.2% (95% CI 0.6% to 1.7%) lower prevalence of cognitive impairment than people without diabetes. Differences persisted even when adjusting for demographic, socioeconomic and geographical characteristics. Rural versus urban residence modified the relationships of diabetes with cognitive score (p=0.001) and cognitive impairment (p=0.003). In fully adjusted models, rural respondents with diabetes had 0.05 SD (95% CI 0.03 to 0.07) greater cognitive scores and 1.6% (95% CI 0.9% to 2.4%) lower prevalence of cognitive impairment than those without diabetes. In urban areas, respondents with and without diabetes had similar cognitive scores and prevalence of cognitive impairment.
Middle-aged and older adults with diabetes living in India had better cognitive health than those without diabetes. Rural versus urban area of residence modified this relationship. Urban-rural differences, the nutrition transition and social conditions likely influenced the cross-sectional relationship between diabetes and cognitive health in India, leading to different associations than reported in other countries.
大多数关于糖尿病与认知健康关系的研究都使用了高收入国家的数据。本研究描述了在世界上人口最多的国家印度的这种关系。
对2017年至2019年进行的具有全国代表性的印度纵向老龄化研究基线波进行横断面分析。
印度所有36个邦和联邦属地。
57905名45岁及以上的成年人。
标准化认知得分（均值为0，标准差为1）以及认知障碍，认知障碍定义为认知得分比年龄匹配和教育匹配的均值低1.5个标准差或更低。糖尿病定义为健康专业人员先前诊断为糖尿病的自我报告或测量的糖化血红蛋白A1c≥6.5%。
在年龄调整和性别调整模型中，糖尿病患者的认知得分比无糖尿病患者高0.24个标准差（95%可信区间0.22至0.26），认知障碍患病率比无糖尿病患者低1.2%（95%可信区间0.6%至1.7%）。即使在调整了人口统计学、社会经济和地理特征后，差异仍然存在。农村与城市居住情况改变了糖尿病与认知得分（p=0.001）和认知障碍（p=0.003）之间的关系。在完全调整模型中，患有糖尿病的农村受访者的认知得分比无糖尿病者高0.05个标准差（95%可信区间0.03至0.07），认知障碍患病率比无糖尿病者低1.6%（95%可信区间0.9%至2.4%）。在城市地区，有糖尿病和无糖尿病的受访者的认知得分和认知障碍患病率相似。
生活在印度的患有糖尿病的中老年人的认知健康状况比无糖尿病者更好。农村与城市居住地区改变了这种关系。城乡差异、营养转型和社会状况可能影响了印度糖尿病与认知健康之间的横断面关系，导致与其他国家报道不同的关联。
