台灣地區失智症合併糖尿病之臨床流行病學研究

Clinical Epidemiology Study of Type II Diabetes Mellitus with Dementia in Taiwan

劉俊麟(Chun-Lin Liu)

指導教授 ： 劉景寬

共同指導教授 ： 吳明蒼(Ming-Tsang Wu)

高雄醫學大學/醫學院/臨床醫學研究所博士班/博士(2019年)

摘要

摘要
背景：失智症的發病率正在迅速增長，並影響到全世界的許多人。 第二型糖尿病（DM）可能：（1）誘導認知衰退和失智，（2）縮短病患壽命。我們的研究探討了失智症患者第二型糖尿病相關的因素。
方法：首先，在1997年至2008年的國家健康保險研究數據庫中確定了患有血管性失智症的患者（40,404位），並將其分為醣尿病組和非糖尿病組。11種併發症並分為四組：心血管和腦血管疾病，消化系統疾病，腎臟和代謝系統疾病以及癌症。通過多變量邏輯回歸探討了這些因素與第二型糖尿病的關聯。
       我們分析在1998年至2005年期間所有在台灣新診斷為失智症的第二型糖尿病患者。這些患者被分類為高血糖發作者和未患有高血糖症的患者。
他們是否因失智症診斷後因高血糖住院而入院治療。評估了與死亡率獨立相關的因素。
結果：22.5％的失智症患者罹患糖尿病。可能性較高者如下:女性、年齡比較低、低收入、腎臟和代謝系統疾病。
      5314名患者中，303名至少一次高血糖住院治療。至少有一次高血糖住院治療的患者死亡風險比沒有這種住院治療的患者高30％。其他變項，包括年齡、性別、地理區域、保險金額、鬱血性心衰竭患者、腦血管疾病、腎臟疾病、使用抗高血壓藥物、使用抗脂質藥物和使用胰島素與風險獨立相關死亡。
結論：本研究結果表明，臨床醫師應鼓勵失智症患者接受定期血糖篩檢，如果他們是女性，社會經濟地位低，或罹患腎臟/代謝疾病。嚴重的高血糖症在患有癡呆症的第二型糖尿病患者中很常見，並且它大大縮短了他們的生命。
關鍵詞：第二型糖尿病、合併症、失智症、社會經濟狀況、高血糖住院

關鍵字

第二型糖尿病 ； 合併症 ； 失智症 ； 社會經濟狀況 ； 高血糖住院

並列摘要

Abstract

Backgrounds: The incidence of dementia is growing rapidly and affects many people worldwide. Type 2 diabetes mellitus (DM) might: (1). inducing cognitive decline and dementia, (2).shortening the life time. Our study explored the factors associated with type 2 DM in patients with dementia.
Methods: Firstly, patients (n = 40,404) with vascular dementia were identified in Taiwan’s 1997 to 2008 National Health Insurance Research Database and divided into a DM group and non-DM group. Eleven comorbidities were identified and categorized into four groups: cardiovascular and cerebrovascular diseases, digestive system diseases, renal and metabolic system diseases, and cancer. The associations of these factors with type 2 DM were explored through multi-variable logistic regression.
We also enrolled all type 2 DM patients newly diagnosed as having dementia in Taiwan from1998 to 2005.These patients were categorized into those who had hyperglycemia episodes and those who did not based on
whether or not they had been hospitalized for hyperglycemia after dementia diagnosis. Factors independently associated with mortality were evaluated.
Results: 22.5% patients with dementia had DM. Associated with a higher likelihood of DM in this population were female sex (adjusted odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.36–1.52), young age (range of adjusted OR: 0.55–1.13), low income (range of adjusted OR: 1.09–1.18), and renal and metabolic system diseases (OR: 2.81, 95% CI: 2.64–2.98).
5314 patients identified, 303 (5.7%) had at least one hyperglycemia hospitalization. Patients with at least one hyperglycemia hospitalization had a 30% greater risk of mortality than those who had no such admissions (adjusted hazard ratio: 1.30, 95% confidence interval: 1.09–1.55). Other variables, including age, sex, geographical region, insurance amount, patient with congestive heart failure, cerebrovascular disease, renal disease, use of anti-hypertensive drugs, use of anti-lipid drugs, and use of insulin were independently associated with risk of mortality.

並列關鍵字

Type 2 diabetes ； Comorbidity ； Dementia ； Socioeconomic status ； hyperglycemia hospitalization

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