番茄社区

WASHINGTON -- Patients with type 1 diabetes are at higher risk of developing dementia later in life than the general population, researchers reported here.

In an analysis of more than 490,000 patient records from Kaiser Permanente Northern California, those with type 1 diabetes had a significantly higher risk of cognitive impairment in older age compared with controls (HR 1.83, 95% CI 1.3-2.5), , of Kaiser Permanente Northern California, reported here at the .

The findings remained significant after controlling for vascular risk factors such as stroke, peripheral arterial disease (PAD), and hypertension, as well as when compared with healthy patients who didn't have type 2 disease.

"We know a lot about type 2 diabetes and how vascular risk factors and poor glycemic control can elevate risk for dementia, but we also need to look at this risk in type 1," Whitmer said. "Type 2 diabetes is the larger public health issue, but we should be thinking about type 1 as well."

Studies have indeed shown that type 2 diabetes is associated with dementia risk, but there's been less work on a potential link between type 1 disease and cognitive impairment.

"There's certainly been a lot on type 2 diabetes and development of dementia, but I'm not aware of similar findings in older type 1 [patients]," , of the University of North Carolina at Chapel Hill, who wasn't involved in the study, told 番茄社区.

Kirkman noted that the DCCT/EDIC study, which has been running now for more than 30 years, has performed some cognitive testing on their patients whose average age may now be in the late 50s, but analyses have not revealed much, and the study has a smaller and more controlled population to begin with, she said.

Whitmer said it's critical to look at this group because studies have shown that just like with type 2 diabetes, the prevalence of type 1 diabetes is also on the rise -- the SEARCH study found that it rose 21% from 2001 to 2009.

For their study, Whitmer and colleagues looked at 490,334 patients treated at Kaiser Permanente over 12 years, from 2002 to 2014. The mean age at baseline was 71, 68% were white, and 55% were female.

A total of 334 patients had type 1 diabetes, and 53 of them were diagnosed with dementia, amounting to about 16%, compared with 12% of the rest of the population that developed dementia.

That translated to an 83% increased risk for developing cognitive impairment, which remained significant at a 61% increase in further analyses that controlled for stroke, PAD, and hypertension.

Whitmer and colleagues subsequently excluded patients with type 2 diabetes from the control population and found an even higher dementia risk for those with type 1 diabetes (HR 1.93, 95% CI 1.3-2.6).

That association also remained elevated and significant after controlling for vascular risk factors (HR 1.73, 95% CI 1.3-2.3).

"We need to identify ways that this population can age well," Whitmer said during a press briefing.

While the exact mechanisms by which type 1 diabetes and cognitive decline are linked aren't yet clear, Whitmer said studies in type 2 diabetes have shown that hypoglycemia is a strong risk factor for dementia, as is poor glycemic control in general.

Her group is just about to start another study, also sponsored by the National Institute on Aging, that will assess cognitive function in older type 1 diabetics over a prospective 5-year period.

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