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Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC Study
The Lancet Diabetes & Endocrinology ( IF 44.5 ) Pub Date : 2021-05-27 , DOI: 10.1016/s2213-8587(21)00086-3
Alan M Jacobson 1 , Christopher M Ryan 2 , Barbara H Braffett 3 , Rose A Gubitosi-Klug 4 , Gayle M Lorenzi 5 , José A Luchsinger 6 , Victoria R Trapani 3 , Ionut Bebu 3 , Naomi Chaytor 7 , Susan M Hitt 8 , Kaleigh Farrell 4 , John M Lachin 3 ,
Affiliation  

Background

With improved treatment, individuals with type 1 diabetes are living longer but there is limited information on the effects of type 1 diabetes on cognitive ability as they become older adults. We followed up individuals with type 1 diabetes to identify independent risk factors for cognitive decline as people age.

Methods

1051 participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. Participants completed cognitive assessments at baseline (median age 27 years) and 2, 5, 18, and 32 years later (median age 59). HbA1c levels, frequency of severe hypoglycaemia, non-glycemic risk factors such as elevated blood pressure, and microvascular and macrovascular complications were assessed repeatedly. We examined the effects of these on measures of memory and psychomotor and mental efficiency. These studies are registered with clinicaltrials.gov, NCT00360815 (DCCT) and NCT00360893 (EDIC).

Findings

Over 32 years of follow-up, we found substantive declines in memory and psychomotor and mental efficiency. Between 18 and 32 years of follow-up, the decline in psychomotor and mental efficiency was five times larger than the change from baseline to year 18. Independent of the other risk factors and comorbidities, exposure to higher HbA1c levels, more episodes of severe hypoglycaemia, and elevated systolic blood pressure were associated with greater decrements in psychomotor and mental efficiency that was most notable by year 32 (p<0·0001). The combined effect of the presence of these three risk factors is the equivalent to an additional 9·4 years of age.

Interpretation

Cognitive function declines with ageing in type 1 diabetes. The association of glycaemia and blood pressure levels with cognitive decline suggests that better management might preserve cognitive function.

Funding

United States National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease.



中文翻译:

老年 1 型糖尿病患者的认知能力下降:DCCT 和 EDIC 研究 32 年随访结果

背景

随着治疗的改进,1 型糖尿病患者的寿命更长,但关于 1 型糖尿病对老年人认知能力影响的信息有限。我们对 1 型糖尿病患者进行了随访,以确定随着年龄增长而导致认知能力下降的独立危险因素。

方法

1051 名 1 型糖尿病患者参加了糖尿病控制和并发症试验 (DCCT) 及其后续糖尿病干预和并发症流行病学 (EDIC) 研究。参与者在基线(中位年龄 27 岁)和 2、5、18 和 32 年后(中位年龄 59 岁)完成认知评估。反复评估HbA 1c水平、严重低血糖的频率、非血糖风险因素(如血压升高)以及微血管和大血管并发症。我们检查了这些对记忆、精神运动和心理效率测量的影响。这些研究在clinicaltrials.gov、NCT00360815 (DCCT) 和NCT00360893 (EDIC) 注册。

发现

在超过 32 年的随访中,我们发现记忆力、精神运动和精神效率显着下降。在 18 至 32 年的随访期间,精神运动和精神效率的下降是从基线到第 18 年的变化的五倍。独立于其他风险因素和合并症,暴露于较高的 HbA 1c水平,更多的严重发作低血糖和收缩压升高与精神运动和精神效率的更大下降有关,到 32 年最为显着(p<0·0001)。这三个风险因素的存在的综合影响相当于增加了 9·4 岁。

解释

认知功能随着 1 型糖尿病的衰老而下降。血糖和血压水平与认知能力下降的关联表明,更好的管理可能会保留认知功能。

资金

美国国立卫生研究院、国家糖尿病、消化和肾脏疾病研究所。

更新日期:2021-06-17
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