Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw
{"title":"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","authors":"Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw","doi":"10.1111/dme.70123","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 <i>p</i> > 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 10","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70123","citationCount":"0","resultStr":"{\"title\":\"Associations of glycaemia-related risk factors with dementia and cognitive decline in individuals with type 2 diabetes: A systematic review and meta-analysis\",\"authors\":\"Mahtab Tabesh, Julian W. Sacre, Kanika Mehta, Lei Chen, Seyedeh Forough Sajjadi, Dianna J. Magliano, Jonathan E. Shaw\",\"doi\":\"10.1111/dme.70123\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>To quantify prospective associations of glycaemia-related factors with cognitive decline and all-cause dementia and its subtypes in people with type 2 diabetes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 <i>p</i> > 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. 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Associations of glycaemia-related risk factors with dementia and cognitive decline in individuals with type 2 diabetes: A systematic review and meta-analysis
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.
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.”
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