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【medical-news】2型糖尿病老年患者低血糖增加发生痴呆的危险性

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Low Blood Sugar Raises Risk Of Dementia In Elderly Patients With Type 2 Diabetes
http://www.medicalnewstoday.com/articles/146075.php
A new US study suggests that episodes of hypoglycemia (low blood sugar) raise the risk of dementia in elderly patients with type 2 diabetes, with those who have at least 3 diagnosed episodes having nearly double the risk of those who have had no diagnosed episodes. The researchers suggest that tight glycemic control may be inadvisable for older patients with type 2 diabetes if their treatment causes hypoglycemia.

The study was the work of researchers from the Division of Research, Section of Etiology and Prevention, Kaiser Permanente, Oakland, California, and the Departments of Psychiatry, Neurology and Epidemiology at the University of California, San Francisco and is published in the 15 April online issue of the Journal of the American Medical Association, JAMA.

The authors wrote that although acute hypoglycemia has been linked with cognitive impairment in children with type 1 diabetes, scientists have not yet established whether it might be a risk factor for dementia in older people who have type 2 diabetes.

For the longitudinal cohort study, which lasted from 1980 to 2007, they followed 16,667 patients of mean age 65 years who had type 2 diabetes. The patients were members of a healthcare delivery system in California, and the researchers were primarily interested in investigating hypoglycemic episodes that required hospitalization.

Using hospital records from 1980 to 2002, the researchers collected and reviewed data on hypoglycemic events and pulled out those that related to elderly patients with no prior diagnosis of dementia, mild cognitive impairment or general memory complaints, as of the start of 2003 and followed them, looking for any diagnoses of dementia, until early 2007.

The researchers assessed dementia risk using statistical models and adjusted for potential confounders such as age, sex, race/ethnicity, BMI, how long they had been diabetic, and other disease-related factors.

The results showed that:
1,465 patients (8.8 per cent of the cohort) had at least one episode of diagnosed hypoglycemia.

1,822 patients (11 per cent of the cohort) were diagnosed with dementia during follow up.

Of the patients who had at least one episode of hypoglycemia, 250 (17 per cent) of them were also diagnosed with dementia.

Compared with patients with no hypoglycemia, those who did have it had a higher risk of dementia that went up in tandem with the number of diagnosed episodes, whereby three or more episodes of hypoglycemia was linked to nearly double the risk of dementia..

The hazard ratio (HR) for 1 episode was 1.26 (95 per cent confidence interval [CI] ranged from 1.10 to 1.49); for 2 episodes it was 1.80 (95% CI 1.37-2.36); and for 3 or more it was 1.94 (95% CI 1.42-2.64).

Compared with patients with no history of hypoglycemia, those with such a history had a risk of dementia that went up by 2.39 per cent per year (95% CI, 1.72-3.01%).

The figures didn't change when the researchers added the following information to the model: how often the patients used the medical services, how long they had been members of the health plan, or how long it had been since their initial diabetes diagnosis.

The results were similar when they looked only at emergency department admissions for hypoglycemia (as opposed to hospitalization records).
The researchers concluded that:

"Among older patients with type 2 diabetes, a history of severe hypoglycemic episodes was associated with a greater risk of dementia. Whether minor hypoglycemic episodes increase risk of dementia is unknown."

Principal investigator Dr Rachel A Whitmer, a research scientist with Kaiser Permanente told the press that:

"We know that the brain becomes more vulnerable with age, and we need a better understanding of how glycemic control can affect brain health over the long term."

"This study adds to the evidence base that perhaps we should rethink the notion of very tight glycemic control for our elderly patients with diabetes mellitus."

In the study, Whitmer and colleagues wondered if cognitive impairment from early dementia could somehow be increasing the chance of having a hypoglycemic episode, but they found that even having one or more hypoglycemic episodes in midlife (mean age 52) still presented a 32 per cent higher risk of dementia later.

Co-author Dr Joe Selby, who is the director of the Kaiser Permanente Division of Research, explained:

"Our findings suggest that pursuit of 'tight' glycemic control (ie to hemoglobin A1c levels less than 7 percent) may be inadvisable in older patients with type 2 diabetes if required treatment is causing hypoglycemia."

"Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus."
Rachel A. Whitmer; Andrew J. Karter; Kristine Yaffe; Charles P. Quesenberry, Jr; Joseph V. Selby.
JAMA. 2009;301(15):1565- 1572.
Vol. 301 No. 15, April 15, 2009.

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2009-04-15 23:37 浏览 : 1208 回复 : 4

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本人已认领此文编译，48小时若未提交译文，请其他战友自由认领。

2009-04-16 08:46

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我第一次来科研板块，翻译了一下，请大家修改，先谢谢了。
Low Blood Sugar Raises Risk Of Dementia In Elderly Patients With Type 2 Diabetes
2型糖尿病老年患者低血糖增加发生痴呆的危险性

A new US study suggests that episodes of hypoglycemia (low blood sugar) raise the risk of dementia in elderly patients with type 2 diabetes, with those who have at least 3 diagnosed episodes having nearly double the risk of those who have had no diagnosed episodes. The researchers suggest that tight glycemic control may be inadvisable for older patients with type 2 diabetes if their treatment causes hypoglycemia.

美国一项新的表明：2型糖尿病老年患者发生低血糖事件增加痴呆的危险性。对于那些至少有3次诊断为发生低血糖的患者，其发生痴呆的危险性接近那些没有诊断为发生低血糖患者的2倍。研究者建议：如果2型糖尿病老年患者的治疗措施会引起低血糖，可能不建议对他们进行严格的血糖控制。

The study was the work of researchers from the Division of Research, Section of Etiology and Prevention, Kaiser Permanente, Oakland, California, and the Departments of Psychiatry, Neurology and Epidemiology at the University of California, San Francisco and is published in the 15 April online issue of the Journal of the American Medical Association, JAMA.

这项研究是由来自加利福尼亚奥克兰市Kaiser Permanente研究部病因学和预防医学小组和位于加利福尼亚、旧金山的大学的神经、精神学科和流行病学科的研究者完成的。它发表在4月15日美国医学学会杂志（JAMA）的网络版上。

The authors wrote that although acute hypoglycemia has been linked with cognitive impairment in children with type 1 diabetes, scientists have not yet established whether it might be a risk factor for dementia in older people who have type 2 diabetes.
作者写到虽然在1型糖尿病儿童患者急性低血糖与认知功能障碍有关，但在2型糖尿病老年患者科学家还没确定急性低血糖是否是痴呆的一个危险因素。

For the longitudinal cohort study, which lasted from 1980 to 2007, they followed 16,667 patients of mean age 65 years who had type 2 diabetes. The patients were members of a healthcare delivery system in California, and the researchers were primarily interested in investigating hypoglycemic episodes that required hospitalization.
在1980-2007年的纵向队列研究中，研究者跟踪了16，667例平均年龄为65岁的2型糖尿病患者。这些患者是加利福尼亚医疗服务系统的成员。研究者主要对调查住院病人的低血糖事件感兴趣。

Using hospital records from 1980 to 2002, the researchers collected and reviewed data on hypoglycemic events and pulled out those that related to elderly patients with no prior diagnosis of dementia, mild cognitive impairment or general memory complaints, as of the start of 2003 and followed them, looking for any diagnoses of dementia, until early 2007.
利用1980-2002年医院记录，研究者收集、回顾了低血糖事件的数据并挑出了那些先前没有诊断过痴呆、轻度认知功能障碍或一般记忆障碍的老年患者并把2003年作为起点，跟踪随访，寻找他们诊断为痴呆的情况，持续到2007年初。

The researchers assessed dementia risk using statistical models and adjusted for potential confounders such as age, sex, race/ethnicity, BMI, how long they had been diabetic, and other disease-related factors.
研究者采用统计学模型对痴呆的危险性进行评估并校正了潜在的混淆因素，如年龄、性别、种族、体重指数、患糖尿病的时间和其他疾病相关的因素。

The results showed that:
1,465 patients (8.8 per cent of the cohort) had at least one episode of diagnosed hypoglycemia.
结果显示如下：
1，465例患者（占队列研究例数的8.8%）至少有1次被诊断过发生了低血糖事件。
1,822 patients (11 per cent of the cohort) were diagnosed with dementia during follow up.
1，822例患者在跟踪随访期间（占队列研究例数的11%）被诊断为痴呆。
Of the patients who had at least one episode of hypoglycemia, 250 (17 per cent) of them were also diagnosed with dementia.
在至少发生了1次低血糖的患者中，250（17%）也被诊断为痴呆。

Compared with patients with no hypoglycemia, those who did have it had a higher risk of dementia that went up in tandem with the number of diagnosed episodes, whereby three or more episodes of hypoglycemia was linked to nearly double the risk of dementia..
与没有发生低血糖的患者相比，那些发生了低血糖的患者发生痴呆的危险性更高，并且随着被诊断为低血糖的次数增多，发生痴呆的危险性增大。3次或以上的低血糖事件发生痴呆的危险性增大至接近2倍。

The hazard ratio (HR) for 1 episode was 1.26 (95 per cent confidence interval [CI] ranged from 1.10 to 1.49); for 2 episodes it was 1.80 (95% CI 1.37-2.36); and for 3 or more it was 1.94 (95% CI 1.42-2.64).
1次低血糖事件的危险指数为1.26（95%的可信区间 CI：1.10-1.49）；2次低血糖事件的危险指数为1.80(95% CI 1.37-2.36)；3次或以上的危险指数1.94 (95% CI 1.42-2.64)。

Compared with patients with no history of hypoglycemia, those with such a history had a risk of dementia that went up by 2.39 per cent per year (95% CI, 1.72-3.01%).
与没有糖尿病病史的患者比较，有糖尿病病史的患者发生痴呆的危险性每年上升2.39% (95% CI, 1.72-3.01%)。

The figures didn't change when the researchers added the following information to the model: how often the patients used the medical services, how long they had been members of the health plan, or how long it had been since their initial diabetes diagnosis.
当研究者把以下的信息加到模型中，数据没有变化：患者利用医疗服务的频率，患者作为健康计划成员的时间，或从首次诊断为糖尿病开始的患病时间。

The results were similar when they looked only at emergency department admissions for hypoglycemia (as opposed to hospitalization records).
The researchers concluded that:
当研究者只观察急诊入院的病人（非住院记录）时，结果是相似的。研究者得出结论：

"Among older patients with type 2 diabetes, a history of severe hypoglycemic episodes was associated with a greater risk of dementia. Whether minor hypoglycemic episodes increase risk of dementia is unknown."
“在2型糖尿病老年患者中，有严重低血糖发作史的患者患痴呆的危险性更大。是否较少次数的低血糖发作增加痴呆的危险，这一点没有报道过。“

Principal investigator Dr Rachel A Whitmer, a research scientist with Kaiser Permanente told the press that:
Kaiser Permanente首席研究员Rachel A Whitmer医生，他也是一个研究科学家，告诉新闻界：

"We know that the brain becomes more vulnerable with age, and we need a better understanding of how glycemic control can affect brain health over the long term."
“我们知道随着年龄的增大，大脑变得更加脆弱。我们要更好的理解长时期的血糖控制怎样影响大脑的健康。”

"This study adds to the evidence base that perhaps we should rethink the notion of very tight glycemic control for our elderly patients with diabetes mellitus."
“也许我们应该重新思考对糖尿病老年患者严格控制血糖的观念，这项研究为此增加了证据。”
In the study, Whitmer and colleagues wondered if cognitive impairment from early dementia could somehow be increasing the chance of having a hypoglycemic episode, but they found that even having one or more hypoglycemic episodes in midlife (mean age 52) still presented a 32 per cent higher risk of dementia later.
在这项研究中，Whitmer和他的同事怀疑是否早期痴呆的认知功能障碍可以增加低血糖的发生机会，但是他们发现在中年时期（平均年龄52岁）即使有1次或以上的低血糖事件仍然会增加32%以后发生痴呆的危险。

Co-author Dr Joe Selby, who is the director of the Kaiser Permanente Division of Research, explained:
Kaiser Permanente研究部的主任、共同作者Joe Selby医生解释：
"Our findings suggest that pursuit of 'tight' glycemic control (ie to hemoglobin A1c levels less than 7 percent) may be inadvisable in older patients with type 2 diabetes if required treatment is causing hypoglycemia."
“我们的发现表明：在2型糖尿病老年患者中，如果必须的治疗措施引起低血糖，严格控制血糖（例如：糖化血红蛋白A1c<7%）也许是不被建议的。“

"Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus."
“2型糖尿病老年患者发生低血糖和痴呆的危险性“
Rachel A. Whitmer; Andrew J. Karter; Kristine Yaffe; Charles P. Quesenberry, Jr; Joseph V. Selby.
JAMA. 2009;301(15):1565- 1572.
Vol. 301 No. 15, April 15, 2009.

2009-04-16 12:32

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2型糖尿病老年患者低血糖增加发生痴呆的危险性
美国一项新的表明：2型糖尿病老年患者发生低血糖事件增加痴呆的危险性。对于那些至少有3次诊断为发生了低血糖的患者，其发生痴呆的危险性接近那些没有诊断为发生了低血糖患者的2倍。研究者建议：如果2型糖尿病老年患者的治疗措施会引起低血糖，可能不建议对他们进行严格的血糖控制。
这项研究是由来自加利福尼亚奥克兰市Kaiser Permanente研究部病因学和预防医学小组和位于加利福尼亚、旧金山的大学的神经、精神学科和流行病学科的研究者完成的。它发表在4月15日美国医学学会杂志（JAMA）的网络版上。
作者写到虽然在1型糖尿病儿童患者急性低血糖与认知功能障碍有关，但在2型糖尿病老年患者中科学家还没确定急性低血糖是否是痴呆的一个危险因素。
在1980-2007年的纵向队列研究中，研究者跟踪了16，667例平均年龄为65岁的2型糖尿病患者。这些患者是加利福尼亚医疗服务系统的成员。研究者主要调查住院病人的低血糖事件。
利用1980-2002年医院记录，研究者收集、回顾了发生低血糖事件的数据并选择那些先前没有诊断过痴呆、轻度认知功能障碍或一般记忆障碍的老年患者并把2003年作为起点，跟踪随访，寻找他们诊断为痴呆的情况，持续到2007年初。
研究者采用统计学模型对痴呆的危险性进行评估并校正了潜在的混淆因素，如年龄、性别、种族、体重指数、患糖尿病的时间和其他疾病相关的因素。
结果显示如下：
1，465例患者（占队列研究例数的8.8%）至少有1次被诊断过发生了低血糖事件。
1，822例患者在跟踪随访期间（占队列研究例数的11%）被诊断了痴呆。
在至少发生了1次低血糖的患者中，250（17%）也被诊断了痴呆。
与没有发生低血糖的患者相比，那些发生了低血糖的患者发生痴呆的危险性更高，并且随着被诊断为低血糖的次数增多，发生痴呆的危险性增大。3次或以上的低血糖事件发生痴呆的危险性增大至接近2倍。
1次低血糖事件的危险指数为1.26（95%的可信区间 CI：1.10-1.49）；2次低血糖事件的危险指数为1.80(95% CI 1.37-2.36)；3次或以上的危险指数1.94 (95% CI 1.42-2.64)。
与没有糖尿病病史的患者比较，有糖尿病病史的患者发生痴呆的危险性每年上升2.39% (95% CI, 1.72-3.01%)。
当研究者把以下的信息加到模型中，得到的数据没有变化：患者利用医疗服务的频率，患者作为健康计划成员的时间，或从首次诊断为糖尿病开始的患病时间。
当研究者只观察急诊入院的病人（非住院记录）时，结果是相似的。
作者得出结论：“在2型糖尿病老年患者中，有严重低血糖发作史的患者患痴呆的危险性更大。是否较少次数的低血糖发作增加痴呆的危险，这一点没有报道过。“
Kaiser Permanente首席研究员Rachel A Whitmer医生，也是一个研究科学家，告诉新闻界：“我们知道随着年龄的增大，大脑变得更加脆弱。我们要更好的理解长时期的血糖控制怎样影响大脑的健康。也许我们应该重新思考对糖尿病老年患者严格控制血糖的观念，这项研究为此增加了证据。”
在这项研究中，Whitmer和他的同事怀疑是否早期痴呆的认知功能障碍可以增加低血糖的发生机会，但是他们发现在中年时期（平均年龄52岁）即使有1次或以上的低血糖事件仍然会增加32%以后发生痴呆的危险。
Kaiser Permanente研究部的主任、共同作者Joe Selby医生解释：“我们的发现表明：在2型糖尿病老年患者中，如果必须的治疗措施引起低血糖，严格控制血糖（例如：糖化血红蛋白A1c<7%）也许是不被建议的。“
“2型糖尿病老年患者发生低血糖和痴呆的危险性“
由于我翻译水平有限，恳请大家提意见！

2009-04-16 12:50

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