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- Title
Association Between Age at Diabetes Onset and Subsequent Risk of Dementia.
- Authors
Barbiellini Amidei, Claudio; Fayosse, Aurore; Dumurgier, Julien; Machado-Fragua, Marcos D.; Tabak, Adam G.; van Sloten, Thomas; Kivimäki, Mika; Dugravot, Aline; Sabia, Séverine; Singh-Manoux, Archana
- Abstract
<bold>Importance: </bold>Trends in type 2 diabetes show an increase in prevalence along with younger age of onset. While vascular complications of early-onset type 2 diabetes are known, the associations with dementia remains unclear.<bold>Objective: </bold>To determine whether younger age at diabetes onset is more strongly associated with incidence of dementia.<bold>Design, Setting, and Participants: </bold>Population-based study in the UK, the Whitehall II prospective cohort study, established in 1985-1988, with clinical examinations in 1991-1993, 1997-1999, 2002-2004, 2007-2009, 2012-2013, and 2015-2016, and linkage to electronic health records until March 2019. The date of final follow-up was March 31, 2019.<bold>Exposures: </bold>Type 2 diabetes, defined as a fasting blood glucose level greater than or equal to 126 mg/dL at clinical examination, physician-diagnosed type 2 diabetes, use of diabetes medication, or hospital record of diabetes between 1985 and 2019.<bold>Main Outcomes and Measures: </bold>Incident dementia ascertained through linkage to electronic health records.<bold>Results: </bold>Among 10 095 participants (67.3% men; aged 35-55 years in 1985-1988), a total of 1710 cases of diabetes and 639 cases of dementia were recorded over a median follow-up of 31.7 years. Dementia rates per 1000 person-years were 8.9 in participants without diabetes at age 70 years, and rates were 10.0 per 1000 person-years for participants with diabetes onset up to 5 years earlier, 13.0 for 6 to 10 years earlier, and 18.3 for more than 10 years earlier. In multivariable-adjusted analyses, compared with participants without diabetes at age 70, the hazard ratio (HR) of dementia in participants with diabetes onset more than 10 years earlier was 2.12 (95% CI, 1.50-3.00), 1.49 (95% CI, 0.95-2.32) for diabetes onset 6 to 10 years earlier, and 1.11 (95% CI, 0.70-1.76) for diabetes onset 5 years earlier or less; linear trend test (P < .001) indicated a graded association between age at onset of type 2 diabetes and dementia. At age 70, every 5-year younger age at onset of type 2 diabetes was significantly associated with an HR of dementia of 1.24 (95% CI, 1.06-1.46) in analyses adjusted for sociodemographic factors, health behaviors, and health-related measures.<bold>Conclusions and Relevance: </bold>In this longitudinal cohort study with a median follow-up of 31.7 years, younger age at onset of diabetes was significantly associated with higher risk of subsequent dementia.
- Subjects
UNITED Kingdom; AGE factors in disease; TYPE 2 diabetes; DEMENTIA risk factors; TYPE 2 diabetes complications; ELECTRONIC health records; RESEARCH; MULTIVARIATE analysis; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; DEMENTIA; LONGITUDINAL method; DISEASE complications
- Publication
JAMA: Journal of the American Medical Association, 2021, Vol 325, Issue 16, p1640
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2021.4001