法国巴黎大学Archana Singh-Manoux团队研究了糖尿病发病年龄与痴呆风险的相关性。2021年4月27日，《美国医学会杂志》发表了这一成果。

2型糖尿病的发病趋势显示，随着发病年龄的降低，患病率持续增加。虽然早发2型糖尿病的血管并发症众所周知，但与痴呆症的关系仍不清楚。

为了探讨糖尿病发病年龄越小是否与痴呆发病风险有更密切的关系，研究组在英国进行了一项基于人群的研究，即白厅II前瞻性队列研究，设立于1985-1988年，参与者在1991-1993年、1997-1999年、2002-2004年、2007-2009年、2012-2013年和2015-2016年进行临床检查，并与电子健康记录挂钩，直到2019年3月。最终随访日期为2019年3月31日。2型糖尿病，定义为临床检查时空腹血糖水平大于或等于126 mg/dL、医生诊断为2型糖尿病、使用糖尿病药物、或1985年至2019年期间的糖尿病住院记录。通过电子健康记录链接来确定糖尿病事件。

10095名参与者中67.3%为男性，平均随访31.7年，研究组共记录了1710例糖尿病患者和639例痴呆患者。在70岁时无糖尿病的参与者中，每1000人-年的痴呆率为8.9；在5年前发病的参与者中，每1000人-年痴呆率为10.0；在6至10年前发病的参与者中，每1000人-年痴呆率为13.0；在10年前发病的参与者中，每1000人-年痴呆率为18.3。

在多变量校正分析中，与70岁时无糖尿病的参与者相比，10年前患糖尿病患者痴呆的风险比为2.12，6-10年前患糖尿病患者痴呆的风险比为1.49，糖尿病发病时间少于5年的患者痴呆的风险比为1.11；线性趋势检验表明2型糖尿病发病年龄与痴呆之间存在分级关联。在对社会人口因素、健康行为和健康相关措施进行校正后的分析中，70岁时，2型糖尿病发病年龄每年轻5岁，痴呆的风险比为1.24。

这项长达31.7年的纵向队列研究表明，糖尿病发病年龄越小，后续患痴呆症的风险越高。

附：英文原文

Title: Association Between Age at Diabetes Onset and Subsequent Risk of Dementia

Author: Claudio Barbiellini Amidei, Aurore Fayosse, Julien Dumurgier, Marcos D. Machado-Fragua, Adam G. Tabak, Thomas van Sloten, Mika Kivimki, Aline Dugravot, Séverine Sabia, Archana Singh-Manoux

Issue&Volume: 2021/04/27

Abstract:

Importance  Trends in type 2 diabetes show an increase in prevalence along with younger age of onset. While vascular complications of early-onset type 2 diabetes are known, the associations with dementia remains unclear.

Objective  To determine whether younger age at diabetes onset is more strongly associated with incidence of dementia.

Design, Setting, and Participants  Population-based study in the UK, the Whitehall II prospective cohort study, established in 1985-1988, with clinical examinations in 1991-1993, 1997-1999, 2002-2004, 2007-2009, 2012-2013, and 2015-2016, and linkage to electronic health records until March 2019. The date of final follow-up was March 31, 2019.

Exposures  Type 2 diabetes, defined as a fasting blood glucose level greater than or equal to 126 mg/dL at clinical examination, physician-diagnosed type 2 diabetes, use of diabetes medication, or hospital record of diabetes between 1985 and 2019.

Main Outcomes and Measures  Incident dementia ascertained through linkage to electronic health records.

Results  Among 10095 participants (67.3% men; aged 35-55 years in 1985-1988), a total of 1710 cases of diabetes and 639 cases of dementia were recorded over a median follow-up of 31.7 years. Dementia rates per 1000 person-years were 8.9 in participants without diabetes at age 70 years, and rates were 10.0 per 1000 person-years for participants with diabetes onset up to 5 years earlier, 13.0 for 6 to 10 years earlier, and 18.3 for more than 10 years earlier. In multivariable-adjusted analyses, compared with participants without diabetes at age 70, the hazard ratio (HR) of dementia in participants with diabetes onset more than 10 years earlier was 2.12 (95% CI, 1.50-3.00), 1.49 (95% CI, 0.95-2.32) for diabetes onset 6 to 10 years earlier, and 1.11 (95% CI, 0.70-1.76) for diabetes onset 5 years earlier or less; linear trend test (P<.001) indicated a graded association between age at onset of type 2 diabetes and dementia. At age 70, every 5-year younger age at onset of type 2 diabetes was significantly associated with an HR of dementia of 1.24 (95% CI, 1.06-1.46) in analyses adjusted for sociodemographic factors, health behaviors, and health-related measures.

Conclusions and Relevance  In this longitudinal cohort study with a median follow-up of 31.7 years, younger age at onset of diabetes was significantly associated with higher risk of subsequent dementia.

DOI: 10.1001/jama.2021.4001

Source: https://jamanetwork.com/journals/jama/article-abstract/2779197