Incidence of Dementia is Increased in Type 2 Diabetes and Reduced by the Use of Sulfonylureas and Metformin
Incidence of Dementia is Increased in Type 2 Diabetes and Reduced by the Use of Sulfonylureas and Metformin
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DOI：
10.3233/jad-2011-101524
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发表时间：
2011-01-01
影响因子：
4
通讯作者：
Tsai, Hsin-Ni
中科院分区：
文献类型：
--
作者：
Hsu, Chih-Cheng;Wahlqvist, Mark L.;Tsai, Hsin-Ni
为了确定2型糖尿病（T2 DM）患者痴呆的发病率，以及口服药物（OA）对DM是否有不良或有利的影响，我们从台湾全民健康保险数据库中获得了80万人的代表性队列。随访至2007年12月31日，对截至2000年1月1日年龄在50岁或以上且无痴呆的患者（n = 127，209）进行了随访，包括是否存在T2 DM（n = 101，816）或存在T2 DM（n = 25，393）以及是否使用了任何OA。通过ICD 9-CM或A代码确定痴呆。痴呆发病率密度（DID）和完全校正的考克斯比例风险模型用于估计痴呆、DM和OA之间的关联。值得注意的是，与无DM受试者相比，DM（未用药）的DID（每10，000人-年）显著增加（119 vs 46）。使用非DM作为参考，不伴OA和伴OA的DM的校正风险比（HR）（95%置信区间）分别为2.41（2.17-2.66）和1.62（1.49-1.77）。对于T2 DM，与不用药相比，单独使用磺脲类药物可将HR从1降至0.85（0.71-1.01），单独使用二甲双胍可将HR降至0.76（0.58-0.98），而联合口服治疗的HR为0.65（0.56-0.74）。调整包括脑血管疾病，以便发现磺脲类药物和二甲双胍治疗的糖尿病患者中非卒中相关性痴呆减少。T2 DM使痴呆的风险增加2倍以上。另一方面，磺脲类药物可能降低痴呆的风险，二甲双胍也是如此;这两种OA在8年内将T2 DM患者的痴呆风险降低了35%。
To determine incidence of dementia in type 2 diabetic (T2DM) patients, and whether there are adverse or favorable effects of oral agents (OA) in DM, we obtained a representative cohort of 800,000 from Taiwan's National Health Insurance database. Those who, as of on January 1, 2000, were 50 years or older and dementia free (n = 127,209) were followed until December 31, 2007, in relation to absence (n = 101,816) or presence (n = 25,393) of T2DM, and whether any OA was used. Dementia was ascertained by ICD9-CM or A-code. Dementia incidence densities (DID) and fully adjusted Cox proportional hazard models were used to estimate association between dementia, DM, and OA. Notably, DID (per 10,000 person-years) was markedly increased with DM (without medication), compared to DM free subjects (119 versus 46). Using non-DM as reference, the adjusted hazard ratios (HRs) (95% confidence interval) for DM without and with OA were 2.41 (2.17-2.66) and 1.62 (1.49-1.77), respectively. For T2DM, compared with no medication, sulfonylureas alone reduced the HR from 1 to 0.85 (0.71-1.01), metformin alone to 0.76 (0.58-0.98), while with combined oral therapy the HR was 0.65 (0.56-0.74). Adjustments included cerebrovascular diseases so that non-stroke related dementias were found to be decreased in DM with sulfonylurea and metformin therapy. T2DM increases the risk of dementia more than 2-fold. On the other hand, sulfonylureas may decrease the risk of dementia, as does metformin; together, these 2 OAs decrease the risk of dementia in T2DM patients by 35% over 8 years.