糖尿病與失智症之文獻回顧

Diabetes Mellitus and Dementia : A Literature Review

林毅欣(Yi-Hsin Lin)

《內科學誌》 29卷2期 (2018/04) Pp. 86-91

https://doi.org/10.6314/JIMT.201804_29(2).05

摘要

隨全球人口快速老化，老年化的社會面臨到糖尿病與失智症等許多慢性疾病與日俱增。糖尿病是失智症的危險因子，失智症可能是糖尿病的併發症。兩者交互影響著治療與預後。本篇文獻主要回顧，糖尿病導致認知功能障礙的可能機轉、抗糖尿病藥物對認知功能的影響、高齡失智糖尿病患者(大於65歲)的治療要點。目前已知短期使用抗糖尿病藥物可以改善糖尿病患者的認知功能下降，但對於長期使用、或是否嚴格控制血糖對認知功能，仍未有結論。部分抗糖尿病藥物似乎對改善或預防失智症是有幫助的，未來需要進一步大規模前瞻性的研究。然而糖尿病的治療需以病人為中心、個別化治療，而改善或預防失智症為其附加價值。尤其高齡患者特別要注意預防低血糖為治療首要目標，避免因過度積極治療而造成的低血糖，導致對認知功能的影響。

關鍵字

失智症(Dementia) ； 糖尿病(Diabetes mellitus) ； 抗糖尿病藥物(Antidiabetic medication)

並列摘要

As populations around the world are aging rapidly, patients with diabetes mellitus and dementia are increasing. It has been well known that diabetes mellitus (DM) is a risk factor for dementia, and dementia is one of the complications of DM. This review will discuss the mechanisms of cognitive impairment in diabetic patients, the effects of antidiabetic medications on cognition, and the crucial points of treatment for older (over the age of 65 years) diabetic patient with cognitive impairment. It is mostly important to prevent hypoglycemia to reduce the risk of cognitive decline. The optimal level of blood glucose lowering and the best selection of medications for the prevention of dementia should be explored in future studies.