Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study.
Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study.
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DOI：
10.1007/s00125-018-4668-1
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发表时间：
2018-09
期刊：
影响因子：
8.2
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Lee AK;Rawlings AM;Lee CJ;Gross AL;Huang ES;Sharrett AR;Coresh J;Selvin E
我们的目的是评估严重低血糖与2型糖尿病成人中特定领域认知功能下降、脑体积缩小和痴呆之间的联系，迄今为止，这种联系的特征相对较差。我们纳入了来自社区动脉粥样硬化风险（ARIC）研究的诊断为糖尿病的参与者。在参与者的第五次研究访视（2011-2013）中，我们检查了重度低血糖与认知状态、脑容量和既往15年认知下降的横断面相关性。我们还对基线访视4（1996-1998）至2013年12月31日期间的痴呆事件进行了前瞻性分析。使用ICD-9编码，从住院、急诊科访视和救护车记录中识别重度低血糖。既往认知下降定义为从访视4（1996-1998）至访视5（2011-2013）的神经心理学测试评分变化。在第5次访视时，一部分参与者接受了脑部MRI检查。对人口统计学、APOE基因型、糖尿病药物的使用、糖尿病持续时间和血糖控制进行了调整。在2001例访视5时患有糖尿病的受试者（平均年龄76岁）中，重度低血糖史（3.1%的受试者）与痴呆相关（vs正常认知状态）：OR 2.34（95% CI 1.04，5.27）。在接受脑部MRI的受试者亚组（n=580）中，低血糖与总脑体积较小相关（-0.308 SD，95% CI-0.612，-0.004）。低血糖与15年认知变化名义上相关（-0.14 SD，95% CI-0.34，0.06）。在前瞻性分析（n=1263）中，低血糖与痴呆事件密切相关（HR 2.54，95% CI 1.78，3.63）。我们的研究结果表明，严重低血糖和认知功能不良之间存在密切联系，这表明需要讨论高危老年人的适当糖尿病治疗方法。
We aimed to evaluate the link between severe hypoglycaemia and domain-specific cognitive decline, smaller brain volumes and dementia in adults with type 2 diabetes, which so far has been relatively poorly characterised. We included participants with diagnosed diabetes from the community-based Atherosclerosis Risk in Communities (ARIC) study. At the participants’ fifth study visit (2011–2013), we examined the cross-sectional associations of severe hypoglycaemia with cognitive status, brain volumes and prior 15 year cognitive decline. We also conducted a prospective analysis of incident dementia from baseline, visit 4 (1996–1998), to 31 December 2013. Severe hypoglycaemia was identified, using ICD-9 codes, from hospitalisations, emergency department visits and ambulance records. Prior cognitive decline was defined as change in neuropsychological test scores from visit 4 (1996–1998) to visit 5 (2011–2013). At visit 5, a subset of participants underwent brain MRIs. Analyses were adjusted for demographics, APOE genotype, use of diabetes medication, duration of diabetes and glycaemic control. Among 2001 participants with diabetes at visit 5 (mean age 76 years), a history of severe hypoglycaemia (3.1% of participants) was associated with dementia (vs normal cognitive status): OR 2.34 (95% CI 1.04, 5.27). In the subset of participants who had undergone brain MRI (n=580), hypoglycaemia was associated with smaller total brain volume (−0.308 SD, 95% CI −0.612, −0.004). Hypoglycaemia was nominally associated with a 15 year cognitive change (−0.14 SD, 95% CI −0.34, 0.06). In prospective analysis (n=1263), hypoglycaemia was strongly associated with incident dementia (HR 2.54, 95% CI 1.78, 3.63). Our results demonstrate a strong link between severe hypoglycaemia and poor cognitive outcomes, suggesting a need for discussion of appropriate diabetes treatments for high-risk older adults.
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影响因子：
11.1
作者：
Lin, C. -H.;Sheu, W. H. -H.
通讯作者：
Sheu, W. H. -H.
影响因子：
29
作者：
Gottesman, Rebecca F.;Albert, Marilyn S.;Knopman, David S.
通讯作者：
Knopman, David S.
影响因子：
16.2
作者：
Schneider ALC;Selvin E;Sharrett AR;Griswold M;Coresh J;Jack CR Jr;Knopman D;Mosley T;Gottesman RF
通讯作者：
Gottesman RF
影响因子：
5.4
作者：
Gross, Alden L.;Power, Melinda C.;Bandeen-Roche, Karen
通讯作者：
Bandeen-Roche, Karen
DOI：
10.2337/ds16-0006
发表时间：
2017-08-01
期刊：
Diabetes spectrum : a publication of the American Diabetes Association
影响因子：
--
作者：
Vimalananda, Varsha G;DeSotto, Kristine;Shirley, Eric
通讯作者：
Shirley, Eric