M. Jancev, MD1, B. Eliasson, MD2, H.C. Gerstein, MD3, K. Eeg-Olofsson2,4, T. Cukierman-Yaffe5, G.J. Biessels, MD6, J.H. DeVries, MD7, F.L.J. Visseren, MD1, N. Sattar, MD8, T.T. van Sloten, MD1
1Department of Vascular Medicine, Diabetes and Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands; 2Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; 3Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; 4Center of Registries Västra Götaland region, Gothenburg, Sweden; 5Division of Endocrinology and Metabolism, Sheba Medical Center, Epidemiology Department, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 6Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands; 7Department of Endocrinology, Amsterdam University Medical Center, Amsterdam, The Netherlands; 8School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
Background: Dementia is a devastating age-related condition. As life expectancy of individuals with type 1 diabetes has increased, this study aimed to investigate all-cause dementia risk in individuals with type 1 diabetes.
Methods: This study included 43,440 individuals with type 1 diabetes from the Swedish National Diabetes Register and 217,109 age-, sex- and county matched controls from the Swedish general population. Cox regression was used to investigate the risk of all-cause dementia and dementia subtypes (Alzheimer’s disease, vascular dementia, and non-Alzheimer’s-non-vascular dementia). Additionally, the relationship between potential risk factors and all-cause dementia risk in type 1 diabetes was assessed using Cox regression and a gradient boosting model.
Results: After a median follow-up of 14.3 [7.9-20.0] years, dementia was recorded in 530 individuals (1.2%) with type 1 diabetes and in 1,867 matched controls (0.9%) (44% women and mean age 33.0 (14.0) years). Individuals with type 1 diabetes had a higher risk of all-cause dementia (HR 2.02 [95%CI:1.83-2.23], Alzheimer’s disease (HR 1.38 [1.13-1.69]), vascular dementia (HR 3.73 [95%CI:3.07-4.52]) and non-Alzheimer’s-non-vascular dementia (HR 1.87 [95%CI:1.63-2.15]). Risk factors associated with a higher all-cause dementia risk in type 1 diabetes were higher age, lower education level, being single, higher systolic blood pressure, higher HbA1c, history of stroke/transient ischemic attack, history of cardiovascular disease, and longer diabetes duration.
Discussion/Conclusion: Type 1 diabetes is associated with a higher risk of all-cause dementia and dementia subtypes compared to matched controls.