Glucose Levels and Risk of Dementia
Glucose Levels and Risk of Dementia
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DOI：
10.1056/nejmc1311765
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发表时间：
2013-08-08
影响因子：
158.5
通讯作者：
Larson, Eric B.
中科院分区：
文献类型：
--
作者：
Crane, Paul K.;Walker, Rod;Larson, Eric B.
背景：糖尿病是痴呆的一个危险因素。目前尚不清楚血糖水平升高是否会增加非糖尿病患者患痴呆的风险。方法：我们使用来自2067名无痴呆的参与者的35,264个临床血糖水平测量值和10,208个糖化血红蛋白水平测量值来检查血糖水平与痴呆风险之间的关系。参与者来自成人思维变化研究，包括839名男性和1228名女性，平均基线年龄为76岁；232名参与者患有糖尿病，1835名没有。我们拟合Cox回归模型，根据糖尿病状况分层，并根据年龄、性别、研究队列、教育水平、运动水平、血压、冠状动脉和脑血管疾病、心房颤动、吸烟和高血压治疗状况进行调整。在中位6.8年的随访期间，524名参与者出现痴呆（74名患有糖尿病，450名没有糖尿病）。在没有糖尿病的参与者中，前5年内较高的平均血糖水平与痴呆风险增加有关（P=0.01）；葡萄糖水平为115毫克/分升（6.4毫摩尔/升）与100毫克/分升（5.5毫摩尔/升）相比，痴呆的调整风险比为1.18（95%置信区间[CI]， 1.04至1.33）。在糖尿病患者中，较高的平均血糖水平也与痴呆风险增加有关（P=0.002）；当血糖水平为190毫克/分升（10.5毫摩尔/升）与160毫克/分升（8.9毫摩尔/升）时，校正风险比为1.40 （95% CI， 1.12至1.76）。结论：研究结果表明，即使在没有糖尿病的人群中，较高的血糖水平也可能是痴呆的一个危险因素。
BACKGROUNDDiabetes is a risk factor for dementia. It is unknown whether higher glucose levels increase the risk of dementia in people without diabetes.METHODSWe used 35,264 clinical measurements of glucose levels and 10,208 measurements of glycated hemoglobin levels from 2067 participants without dementia to examine the relationship between glucose levels and the risk of dementia. Participants were from the Adult Changes in Thought study and included 839 men and 1228 women whose mean age at baseline was 76 years; 232 participants had diabetes, and 1835 did not. We fit Cox regression models, stratified according to diabetes status and adjusted for age, sex, study cohort, educational level, level of exercise, blood pressure, and status with respect to coronary and cerebrovascular diseases, atrial fibrillation, smoking, and treatment for hypertension.RESULTSDuring a median follow-up of 6.8 years, dementia developed in 524 participants (74 with diabetes and 450 without). Among participants without diabetes, higher average glucose levels within the preceding 5 years were related to an increased risk of dementia (P=0.01); with a glucose level of 115 mg per deciliter (6.4 mmol per liter) as compared with 100 mg per deciliter (5.5 mmol per liter), the adjusted hazard ratio for dementia was 1.18 (95% confidence interval [CI], 1.04 to 1.33). Among participants with diabetes, higher average glucose levels were also related to an increased risk of dementia (P=0.002); with a glucose level of 190 mg per deciliter (10.5 mmol per liter) as compared with 160 mg per deciliter (8.9 mmol per liter), the adjusted hazard ratio was 1.40 (95% CI, 1.12 to 1.76).CONCLUSIONSOur results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes.