Associations of glycaemia-related risk factors with dementia and cognitive decline in individuals with type 2 diabetes: A systematic review and meta-analysis

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-08-19 DOI:10.1111/dme.70123

Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw

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引用次数: 0

Abstract

Aims

To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.

Methods

We systematically searched Embase and MEDLINE (January 2000–October 2024) for studies in people with diabetes reporting longitudinal associations of a relevant exposure (i.e. hypoglycaemia, HbA1c, HbA1c variability or diabetes duration) with any of these outcomes: cognitive decline, all-cause dementia, Alzheimer's disease (AD) or vascular dementia (VaD). Data were meta-analysed using a random-effects model followed by meta-regression if appropriate.

Results

Forty studies representing 7,076,724 individuals with diabetes were included. Hypoglycaemia was significantly associated with 49% and 31% higher risks of all-cause dementia and AD, respectively. The pooled effect size did not significantly vary according to age, sex, diabetes duration, smoking, follow-up length, comorbid hypertension, kidney disease, dyslipidaemia or stroke (all p > 0.05). A positive association existed between hypoglycaemia frequency and all-cause dementia, with maximum hazard ratios (HRs) of 2.36–2.60 in the highest exposure group. HbA1c showed a positive risk gradient for all-cause dementia, with maximum significant HRs of 1.40–3.88 for the highest category, while only three studies were available for meta-analysis, with a pooled HR (95% CI) of 1.18 (0.97, 1.45). HbA1c variability and diabetes duration were each significantly associated with a higher risk of dementia. Limited evidence supported a relationship between glycaemia-related factors and cognitive decline.

Conclusions

Having a history of hypoglycaemia, longer diabetes duration, and higher HbA1c levels and variability were related to higher dementia risk in people with type 2 diabetes.

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血糖相关危险因素与2型糖尿病患者痴呆和认知能力下降的关系：一项系统综述和荟萃分析

目的：量化血糖相关因素与2型糖尿病患者认知能力下降和全因痴呆及其亚型的前瞻性关联。方法：我们系统地检索了Embase和MEDLINE（2000年1月- 2024年10月）中糖尿病患者报告的相关暴露（即低血糖、HbA1c、HbA1c变异性或糖尿病持续时间）与以下任何结果（认知能力下降、全因痴呆、阿尔茨海默病（AD）或血管性痴呆（VaD））的纵向关联的研究。使用随机效应模型对数据进行meta分析，然后在适当的情况下进行meta回归。结果：40项研究共纳入7076724例糖尿病患者。低血糖与全因痴呆和阿尔茨海默病的风险分别高出49%和31%显著相关。合并效应大小在年龄、性别、糖尿病病程、吸烟、随访时间、合并症高血压、肾脏疾病、血脂异常或中风等方面无显著差异（均p < 0.05）。低血糖频率与全因痴呆之间存在正相关，最高暴露组的最大危险比（hr）为2.36-2.60。HbA1c显示出全因痴呆的正风险梯度，最高类别的最大显著HR为1.40-3.88，而只有三项研究可用于荟萃分析，合并HR （95% CI）为1.18（0.97,1.45）。HbA1c变异性和糖尿病病程均与痴呆的高风险显著相关。有限的证据支持血糖相关因素与认知能力下降之间的关系。结论：低血糖史、糖尿病病程较长、HbA1c水平和变异性较高与2型糖尿病患者痴呆风险较高相关。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”