Meta-analysis reinforces cognitive toll of DM, pre-DM

  • Xue M & al.
  • Ageing Res Rev
  • 17 Aug 2019

  • International Clinical Digest
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Takeaway

  • Diabetes mellitus (DM), pre-DM, and glycaemic markers were associated with risk for cognitive impairment and dementia, but pioglitazone (Actos) appeared protective.

Why this matters

  • Lack of effective prevention and treatment interventions for dementia.

 Key results

  • Diabetes conferred elevated risks for cognitive disorders (relative risk [RR]; 95% CI):
    • Global cognitive decline (1.25; 1.12-1.39).
    • Executive function decline (1.44; 1.23-1.69).
    • Memory function impairment (1.27; 1.16-1.39).
    • Mild cognitive impairment (1.49; 1.26-1.77).
    • Progression from mild cognitive impairment to dementia (1.91; 1.54-2.36).
    • All-cause dementia (1.43; 1.33-1.53).
    • Alzheimer’s disease (1.43; 1.25-1.62).
    • Vascular dementia (1.91; 1.61-2.25).
  • Prediabetes conferred elevated risks for cognitive disorders (RR; 95% CI):
    • Dementia (1.18; 1.02-1.36).
    • Alzheimer’s disease (1.36; 1.09-1.70).
    • Vascular dementia (1.47; 1.01-2.15).
  • Associations also seen for fasting plasma glucose and insulin, 2-hour postload glucose, glycosylated haemoglobin.
  • Among diabetic patients, risk for dementia (RR; 95% CI):
    • Lower with pioglitazone (0.53; 0.39-0.73).
    • Similar with metformin (Glucophage, others; 0.89; 0.75-1.06).

Study design

  • Systematic review of 144 studies; meta-analysis of 122 studies having more than 4.5 million participants.
  • Main outcomes: cognitive disorders.
  • Funding: National Key R&D Program of China; Shanghai Municipal Science and Technology Major Project; others.

Limitations

  • Some studies possibly missed.
  • Small numbers for certain analyses.
  • Variation controlling for confounders.
  • Low-quality evidence for some associations.

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