Association Between Age at Diabetes Onset and Subsequent Risk of Dementia
Association Between Age at Diabetes Onset and Subsequent Risk of Dementia
复制标题
DOI：
10.1001/jama.2021.4001
复制
发表时间：
2021-04-27
影响因子：
120.7
通讯作者：
Singh-Manoux, Archana
中科院分区：
文献类型：
--
作者：
Amidei, Claudio Barbiellini;Fayosse, Aurore;Singh-Manoux, Archana
2型糖尿病的发病年龄与随后的痴呆风险之间有什么联系？在这项包含10095名参与者的前瞻性队列研究中，2型糖尿病发病年龄越小，痴呆发病风险越高;在70岁时，2型糖尿病发病年龄每提前5年的风险比为1.24。2型糖尿病发病年龄越小，痴呆发生的风险越高。重要性2型糖尿病的发病趋势显示，患病率沿着发病年龄越小。虽然早发性2型糖尿病的血管并发症是已知的，但与痴呆症的关联仍不清楚。目的确定糖尿病发病年龄越小，痴呆发病率越高。设计、设置和样本英国的基于人群的研究，白厅II前瞻性队列研究，建立于1985-1988年，1991-1993年、1997-1999年、2002-2004年、2007-2009年、2012-2013年和2015-2016年进行了临床检查，和电子健康记录的链接，直到2019年3月。最终随访日期为2019年3月31日。暴露2型糖尿病，定义为临床检查时空腹血糖水平大于或等于126 mg/dL，医生诊断的2型糖尿病，使用糖尿病药物或1985年至2019年期间的糖尿病住院记录。主要结果和措施通过与电子健康记录的联系确定的痴呆事件。结果在10095名参与者中（67.3%为男性，年龄35-55岁，1985-1988年），共有1710例糖尿病患者和639例痴呆患者，中位随访时间为31.7年。在70岁时无糖尿病的参与者中，每1000人年的痴呆率为8.9，在5年前糖尿病发作的参与者中，每1000人年的痴呆率为10.0，6至10年前为13.0，10年以上为18.3。在多变量校正分析中，与70岁时无糖尿病的参与者相比，10年前糖尿病发作的参与者痴呆的风险比（HR）为2.12（95%CI，1.50-3.00），发病6 ~ 10年者为1.49（95%CI，0.95-2.32），发病5年或5年以下者为1.11（95%CI，0.70-1.76）;线性趋势检验（P
Key PointsQuestionWhat is the association between age at onset of type 2 diabetes and subsequent risk of dementia? FindingsIn this prospective cohort study of 10095 participants, younger age at onset of type 2 diabetes was significantly associated with higher risk for incident dementia; at age 70, the hazard ratio for every 5-year earlier age at type 2 diabetes onset was 1.24. MeaningYounger age at diabetes onset was associated with higher risk of subsequent dementia.ImportanceTrends in type 2 diabetes show an increase in prevalence along with younger age of onset. While vascular complications of early-onset type 2 diabetes are known, the associations with dementia remains unclear. ObjectiveTo determine whether younger age at diabetes onset is more strongly associated with incidence of dementia. Design, Setting, and ParticipantsPopulation-based study in the UK, the Whitehall II prospective cohort study, established in 1985-1988, with clinical examinations in 1991-1993, 1997-1999, 2002-2004, 2007-2009, 2012-2013, and 2015-2016, and linkage to electronic health records until March 2019. The date of final follow-up was March 31, 2019. ExposuresType 2 diabetes, defined as a fasting blood glucose level greater than or equal to 126 mg/dL at clinical examination, physician-diagnosed type 2 diabetes, use of diabetes medication, or hospital record of diabetes between 1985 and 2019. Main Outcomes and MeasuresIncident dementia ascertained through linkage to electronic health records. ResultsAmong 10095 participants (67.3% men; aged 35-55 years in 1985-1988), a total of 1710 cases of diabetes and 639 cases of dementia were recorded over a median follow-up of 31.7 years. Dementia rates per 1000 person-years were 8.9 in participants without diabetes at age 70 years, and rates were 10.0 per 1000 person-years for participants with diabetes onset up to 5 years earlier, 13.0 for 6 to 10 years earlier, and 18.3 for more than 10 years earlier. In multivariable-adjusted analyses, compared with participants without diabetes at age 70, the hazard ratio (HR) of dementia in participants with diabetes onset more than 10 years earlier was 2.12 (95% CI, 1.50-3.00), 1.49 (95% CI, 0.95-2.32) for diabetes onset 6 to 10 years earlier, and 1.11 (95% CI, 0.70-1.76) for diabetes onset 5 years earlier or less; linear trend test (P