Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial.
Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial.
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DOI：
10.2337/dc11-1855
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发表时间：
2012-04
期刊：
影响因子：
16.2
通讯作者：
ACCORD-MIND Investigators
中科院分区：
文献类型：
--
作者：
Punthakee Z;Miller ME;Launer LJ;Williamson JD;Lazar RM;Cukierman-Yaffee T;Seaquist ER;Ismail-Beigi F;Sullivan MD;Lovato LC;Bergenstal RM;Gerstein HC;ACCORD Group of Investigators;ACCORD-MIND Investigators
2型糖尿病的自我管理（包括避免低血糖）是复杂的，但认知对安全自我管理的影响还不清楚。本研究旨在评估基线认知功能和认知功能下降对后续严重低血糖风险的影响，并评估不同血糖控制策略对这些关系的影响。雅阁试验数据的前瞻性队列分析包括2，956名年龄≥55岁的2型糖尿病和其他心血管风险因素成人。在基线和20个月时进行认知测试（数字符号替代测试[DSST]、Rey听觉语言学习测试、Stroop测试和简易精神状态检查）。研究结局为事件证实的需要医疗救助的重度低血糖（HMA）和需要任何救助的低血糖（HAA）。中位随访3.25年后，DSST基线评分低5分可预测HMA首次发作（风险比1.13 [95% CI 1.08-1.18]）。其他认知测试和HAA的分析与DSST结果一致。在基线认知功能较低的患者中，20个月以上的认知功能下降在更大程度上增加了随后发生低血糖的风险（P相互作用= 0.037）。随机分配到强化与标准血糖策略对认知功能与严重低血糖风险之间的关系没有影响。认知功能差会增加2型糖尿病患者发生严重低血糖的风险。临床医生在评估和指导患者进行安全的糖尿病自我管理时应考虑认知功能，无论其血糖目标如何。
Self-management of type 2 diabetes including avoidance of hypoglycemia is complex, but the impact of cognition on safe self-management is not well understood. This study aimed to assess the effect of baseline cognitive function and cognitive decline on subsequent risk of severe hypoglycemia and to assess the effect of different glycemic strategies on these relationships. Prospective cohort analysis of data from the ACCORD trial included 2,956 adults aged ≥55 years with type 2 diabetes and additional cardiovascular risk factors. Cognitive tests (Digit Symbol Substitution Test [DSST], Rey Auditory Verbal Learning Test, Stroop Test, and Mini Mental Status Examination) were conducted at baseline and 20 months. Study outcomes were incident confirmed severe hypoglycemia requiring medical assistance (HMA) and hypoglycemia requiring any assistance (HAA). After a median 3.25-year follow-up, a 5-point-poorer baseline score on the DSST was predictive of a first episode of HMA (hazard ratio 1.13 [95% CI 1.08–1.18]). Analyses of the other cognitive tests and of HAA were consistent with the DSST results. Cognitive decline over 20 months increased the risk of subsequent hypoglycemia to a greater extent in those with lower baseline cognitive function (Pinteraction = 0.037). Randomization to an intensive versus standard glycemic strategy had no impact on the relationship between cognitive function and the risk of severe hypoglycemia. Poor cognitive function increases the risk of severe hypoglycemia in patients with type 2 diabetes. Clinicians should consider cognitive function in assessing and guiding their patients regarding safe diabetes self-management regardless of their glycemic targets.
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影响因子：
5.7
作者：
Rosano, C;Simonsick, EM;Newman, AB
通讯作者：
Newman, AB
糖尿病的医疗标准 - 2009年。
影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
基线特征，血糖治疗方法和糖化血红蛋白浓度对严重低血糖风险的影响：协定研究事后流行病学分析。
DOI：
10.1136/bmj.b5444
发表时间：
2010-01-08
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Miller ME;Bonds DE;Gerstein HC;Seaquist ER;Bergenstal RM;Calles-Escandon J;Childress RD;Craven TE;Cuddihy RM;Dailey G;Feinglos MN;Ismail-Beigi F;Largay JF;O'Connor PJ;Paul T;Savage PJ;Schubart UK;Sood A;Genuth S;ACCORD Investigators
通讯作者：
ACCORD Investigators
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.
影响因子：
4
作者：
Lee, David M.;Tajar, Abdelouahid;Wu, Frederick C. W.
通讯作者：
Wu, Frederick C. W.