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The younger the onset of diabetes and the higher the risk of dementia

JAMA: The younger the onset of diabetes and the higher the risk of dementia

JAMA: The younger the onset of diabetes and the higher the risk of dementia.  Diabetes is a metabolic disease characterized by chronically elevated blood sugar levels, which mainly include type 1 diabetes and type 2 diabetes, and its prevalence and incidence have always been high.

The prevalence of type 2 diabetes is rising due to an aging population, increasing obesity, lack of exercise, and energy-intensive diets. More than 90% of diabetic patients suffer from type 2 diabetes. Current studies have shown that diabetes is associated with higher cardiovascular disease morbidity and mortality. Large-scale multi-cohort meta-analysis has shown that the risk ratio between diabetes and dementia is between 1.43 and 1.62. But the main limitation of its research is that it cannot test the importance of age at onset of diabetes to dementia.

The Archana Singh-Manoux team of the University of Paris in France published the research results in the Journal of the American Medical Association, entitled “Association Between Age at Diabetes Onset and Subsequent Risk of Dementia”, which studied the correlation between the age of onset of diabetes and the risk of dementia.

In order to explore whether the younger age at onset of diabetes is more closely related to the risk of dementia, the research team conducted a population-based study in the United Kingdom. This study is called the Whitehall II study and is an ongoing cohort study. From 1985 to 1988, the subjects were 10,308 people (6895 men and 3413 women, aged 35-55) in London.

Starting from the baseline, follow-up clinical examinations will be conducted approximately every 4-5 years, and each cycle needs to be completed in 2 years. Data will be collected continuously during the 2020-2021 cycle and linked to the electronic health record. The relevant recorded data is updated once a year until March 31, 2019. Type 2 diabetes is defined as a fasting blood glucose level greater than or equal to 126 mg/dL at the time of clinical examination, a doctor’s diagnosis of type 2 diabetes, use of diabetes medications, or diabetes hospitalization records from 1985 to 2019.

67.3% of the 10,095 participants were men. The average follow-up was 31.7 years. The research group recorded 1,710 diabetic patients and 639 dementia patients. Among participants without diabetes at the age of 70, the rate of dementia per 1,000 person-years was 8.9; among participants who had onset 5 years ago, the rate of dementia per 1,000 person-years was 10.0; those who had onset between 6 and 10 years ago Among the participants, the dementia rate per 1,000 person-years was 13.0; among the participants who had onset 10 years ago, the dementia rate per 1,000 person-years was 18.3.

In a multivariate adjusted analysis, compared with participants without diabetes at the age of 70, the risk ratio of dementia in diabetic patients 10 years ago was 2.12, and the risk ratio of dementia in diabetic patients 6-10 years ago was 1.49, and the onset time of diabetes The risk ratio of dementia for patients less than 5 years is 1.11; the linear trend test shows that there is a graded association between the age of onset of type 2 diabetes and dementia. In an adjusted analysis of sociodemographic factors, health behaviors, and health-related measures, at the age of 70, the risk ratio of dementia was 1.24 for every 5 years younger at the onset of type 2 diabetes.

The study finally mentioned: The current study does not have strong evidence that there is a link between prediabetes and dementia. Fasting blood glucose within the normal range may not adversely affect brain function. There is only a slight correlation between fasting blood glucose in non-diabetics and the risk of vascular disease. A certain threshold of high glucose levels may be a necessary condition for brain damage induced by hyperglycemia, so it is important to consider whether vascular comorbidities are related to the onset of dementia in diabetic patients.

In summary, in this longitudinal cohort study with a median follow-up of 31.7 years, the younger age at onset of diabetes was significantly associated with a higher risk of subsequent dementia.

 

 

(source:internet, reference only)


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