Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study

• Published in: Journal of diabetes and its complications 2015-11, Vol.29 (8), p.1071-1076
• Main Authors: Kuo, Shu-Chen, Lai, Shih-Wei, Hung, Hung-Chang, Muo, Chih-Hsin, Hung, Shih-Chang, Liu, Ling-Ling, Chang, Chia-Wei, Hwu, Yueh-Juen, Chen, Shieh-Liang, Sung, Fung-Chung
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Alzheimer's disease; Cardiovascular disease; Cohort Studies; Comorbidity; Confidence intervals; Coronary vessels; Dementia; Dementia - chemically induced; Dementia - epidemiology; Dementia - prevention & control; Diabetes; Diabetes Complications - chemically induced; Diabetes Complications - epidemiology; Diabetes Complications - prevention & control; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Electronic Health Records; Endocrinology & Metabolism; Epidemiology; Female; Gender; Health care; Humans; Hypertension; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Insulin - adverse effects; Insulin - therapeutic use; Kaplan-Meier Estimate; Kidney diseases; Longitudinal Studies; Male; Middle Aged; National Health Programs; Patients; Prevalence; Proportional Hazards Models; Retrospective cohort; Retrospective Studies; Risk; Risk Factors; Taiwan - epidemiology
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2015.06.010

Abstract Aims Most diabetes mellitus (DM) patients have several comorbidities; the correlation of these comorbidities with dementia in DM requires clarification. Methods Using claims data from Taiwan National Health Insurance, we identified 33,709 DM adults before the year 2000 and randomly selected 67,066 non-DM patients matched by sex and age. Subjects were followed until diagnosis with dementia, excluded due to death/withdrawal from the insurance program, or followed until 2011. We compared the incidence and hazard ratio (HR) for dementia in both cohorts. Results Comorbidities were more prevalent in DM patients, including hypertension, hyperlipidemia, stroke, coronary artery and/or kidney disease. The HR was higher for the DM cohort with comorbidities than those without: 1.88 vs. 1.46 with hypertension; 1.56 vs. 1.39 with hyperlipidemia; 1.73 vs. 1.37 with coronary artery disease; 2.36 vs. 2.29 with stroke and 1.88 vs. 1.50 with kidney disease. The HR for dementia in diabetics rose from 1.41 in those without comorbidities to 2.49 in those with ≥ 4 comorbidities. In the DM cohort, HR was 1.22 for non-insulin-users and 1.41 for insulin-users, and 1.49 for type 1 DM and 1.23 for type 2 DM. Conclusion Diabetic patients have an elevated risk of dementia, and comorbidity increases this risk.