Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes.
Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes.
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DOI：
10.1016/j.jdiacomp.2016.08.010
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发表时间：
2016-11
影响因子：
3
通讯作者：
Klein R
中科院分区：
文献类型：
--
作者：
Ryan CM;Klein BEK;Lee KE;Cruickshanks KJ;Klein R
轻度认知功能障碍已在儿童和成人1型糖尿病患者中发现，但大多数研究未能发现严重低血糖和认知之间的关系，尽管有报道称老年2型糖尿病患者存在此类关联。我们以1型糖尿病老年人为研究对象，研究了认知能力与近期严重低血糖发作、视网膜血管直径以及微血管和大血管并发症之间的关系。在威斯康星州糖尿病视网膜病变流行病学研究中，对244名参与者的认知功能进行了评估。2012 - 2014年评估时的平均（SD;范围）年龄为55.2（8.3; 37 - 82）岁，糖尿病的平均（SD）病程为41.1（5.6）年。在这项横断面研究中，评估了三个认知领域：心理效率和执行功能，非文字记忆和文字记忆。多变量模型表明，尽管年龄和/或教育程度与心理效率指标的表现最密切相关，但三个糖尿病相关变量也与较差的测试成绩相关：过去一年中发生过严重低血糖（β = −0.360 [95% CI，−0.672，−0.047]），视网膜小动脉和小静脉直径（β = 0.140 [95% CI，0.062，0.219]; β = −0.127 [95% CI −0.207，−0.047]）和颈动脉斑块（β = −0.372 [95% CI −0.741，−0.003]）。此外，近期重度低血糖与非语言记忆较差相关（β = −0.522 [95%CI，−0.849，−0.194]）。对于长期1型糖尿病的中老年患者，认知能力较差与近期严重低血糖发作以及微血管和/或大血管疾病的存在相关。鉴于越来越多的老年1型糖尿病患者，未来的纵向研究需要确定因果关系，并确定是否糖尿病管理技术，减少血管并发症和低血糖的发生或严重程度，也可以降低认知功能障碍的风险在这一人群中。
Mild cognitive dysfunction has been identified in children and adults with type 1 diabetes, but most studies have failed to find a relationship between severe hypoglycemia and cognition, despite reports of such associations in older adults with type 2 diabetes. Focusing on older adults with type 1 diabetes, we examined associations between cognitive performance and recent episodes of severe hypoglycemia, retinal vessel diameters and the presence of micro- and macrovascular complications. Cognitive functioning was assessed in 244 participants enrolled in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. The mean (SD; range) age at assessment in 2012 – 14 was 55.2 (8.3; 37 – 82) years and the mean (SD) duration of diabetes was 41.1 (5.6) years. Three cognitive domains were assessed in this cross-sectional study: mental efficiency and executive function, nonverbal memory, and verbal memory. Multivariate modeling demonstrated that although age and/or education are most strongly associated with performance on measures of mental efficiency, three diabetes-related variables were also associated with poorer test scores: an episode of severe hypoglycemia in the past year (β = −0.360 [95% CI, −0.672, −0.047]), retinal arteriolar and venular diameters (β = 0.140 [95% CI, 0.062, 0.219]; β = −0.127 [95% CI −0.207, −0.047]), and carotid artery plaque (β = −0.372 [95% CI −0.741, −0.003]). In addition, recent severe hypoglycemia was associated with poorer nonverbal memory (β = −0.522 [95% CI, −0.849, −0.194]). For middle-aged and older adults with long-duration type 1 diabetes, poorer cognition was associated with a recent episode of severe hypoglycemia as well as with the presence of micro- and/or macrovascular conditions. Given the increasing numbers of aging adults with type 1 diabetes, future longitudinal studies are needed to identify causality and to determine whether diabetes management techniques that reduce the onset or severity of vascular complications and hypoglycemia can also reduce the risk of cognitive dysfunction in this population.
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影响因子：
11.1
作者：
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通讯作者：
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DOI：
10.1017/s1355617713001483
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2009-07-01
影响因子：
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