Association of Type 2 Diabetes, According to the Number of Risk Factors Within Target Range, With Structural Brain Abnormalities, Cognitive Performance, and Risk of Dementia.
Association of Type 2 Diabetes, According to the Number of Risk Factors Within Target Range, With Structural Brain Abnormalities, Cognitive Performance, and Risk of Dementia.
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2型糖尿病与认知功能障碍和大脑异常的风险增加有关。风险因素修改可在多大程度上缓解这些风险尚不清楚。我们根据目标危险因素的数量，与无糖尿病的对照受试者相比，研究了2型糖尿病患者的痴呆事件、认知能力和大脑异常之间的关系。前瞻性数据来自英国生物银行的87，856名个体（n = 10，663名糖尿病患者，n = 77，193名对照受试者;基线2006-2010），痴呆随访至2018年2月。糖尿病患者根据指南推荐的目标范围内的七个选定的风险因素（不吸烟;指南推荐的糖化血红蛋白水平，血压，BMI，白蛋白尿，体力活动和饮食）进行分类。结果为痴呆事件、特定领域认知表现、白色高信号和总脑容量。在平均随访9.0年后，147名糖尿病患者（1.4%）和412名对照组受试者（0.5%）发生了痴呆症。在糖尿病患者中，对于目标上的更多风险因素，过度痴呆风险逐步降低。与对照组相比（每1,000人年的发病率为0.62 [95%CI 0.56; 0.68]），有5 - 7个危险因素的糖尿病患者没有显著的额外痴呆风险（每1,000人年的绝对率差为0.20 [-0.11; 0.52];风险比为1.32 [0.89; 1.95]）。同样，处理速度、执行功能和脑容量的差异随着目标风险因素的增加而逐渐减小。这些结果在马斯特里赫特研究中得到了重复。在糖尿病患者中，过度痴呆风险，认知能力低下和大脑异常逐步减少，目标风险因素数量更多。
Type 2 diabetes is associated with increased risks of cognitive dysfunction and brain abnormalities. The extent to which risk factor modification can mitigate these risks is unclear. We investigated the associations between incident dementia, cognitive performance, and brain abnormalities among individuals with type 2 diabetes, according to the number of risk factors on target, compared with control subjects without diabetes. Prospective data were from UK Biobank of 87,856 individuals (n = 10,663 diabetes, n = 77,193 control subjects; baseline 2006–2010), with dementia follow-up until February 2018. Individuals with diabetes were categorized according to the number of seven selected risk factors within the guideline-recommended target range (nonsmoking; guideline-recommended levels of glycated hemoglobin, blood pressure, BMI, albuminuria, physical activity, and diet). Outcomes were incident dementia, domain-specific cognitive performance, white matter hyperintensities, and total brain volume. After a mean follow-up of 9.0 years, 147 individuals (1.4%) with diabetes and 412 control subjects (0.5%) had incident dementia. Among individuals with diabetes, excess dementia risk decreased stepwise for a higher number of risk factors on target. Compared with control subjects (incidence rate per 1,000 person-years 0.62 [95% CI 0.56; 0.68]), individuals with diabetes who had five to seven risk factors on target had no significant excess dementia risk (absolute rate difference per 1,000 person-years 0.20 [−0.11; 0.52]; hazard ratio 1.32 [0.89; 1.95]). Similarly, differences in processing speed, executive function, and brain volumes were progressively smaller for a higher number of risk factors on target. These results were replicated in the Maastricht Study. Among individuals with diabetes, excess dementia risk, lower cognitive performance, and brain abnormalities decreased stepwise for a higher number of risk factors on target.