Different glycaemia‐related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes—A sex‐specific analysis of the Hong Kong diabetes database

Abstract

Aims Sexual dimorphism has been reported in the epidemiology, neurobiologic susceptibility and clinical presentation of Alzheimer's disease (AD). As poor glycaemic control is associated with increased risks of AD, we aimed to investigate whether glycaemia‐related risk factors also differ between men and women, using a retrospective, sex‐specific analysis of a large Chinese cohort with diabetes. Materials & Methods A total of 85,514 Chinese individuals with type 2 diabetes (T2D; 46,783 women and 38,731 men), aged ≥60 years, were identified from electronic health records and observed for incident AD. Multivariable Cox regression analysis was used to evaluate the associations with incident AD of several glycaemia‐related risk factors, including severe hypoglycaemia, mean HbA1c and indices of HbA1c variability, in men and women separately. Results Over a median follow‐up of 6 years, women had a higher incidence of AD than men (2.3% vs. 1.2%, p < 0.001). Both men and women shared the same independent non‐glycaemic clinical predictors, which included older age, lower body mass index and longer duration of diabetes. However, for glycaemia‐related risk factors, we observed that severe hypoglycaemia and indices of HbA1c variability were independent predictors of incident AD in women but not in men, and the associations were irrespective of their baseline glycaemic control and duration of diabetes. Conclusions Our findings highlighted that glycaemia‐related risk factors for incident AD differ between men and women with T2D. Strategies to maintain glycaemic stability and avoid severe hypoglycaemia might be especially important to preserve healthy cognition in older women with diabetes.

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

“… 19 With the help of CDARS, high-quality large population-based studies had been published. 19 , 20 , 21 , 22 The HA is the only public-funded healthcare provider providing management to all COVID-19 cases in Hong Kong. Cases of COVID-19 were identified using a combination of ICD-9-CM codes 519.8, 079.89 and V75.9, together with a valid SARS-CoV-2 PCR Ct value.…”

A case for seeking sex-specific treatments in Alzheimer’s disease

“…Many studies suggest that social isolation poses a greater risk of dementia in women but a recent comprehensive review indicates a lack of consensus (Ren et al, 2023) Physical inactivity Evidence suggesting a sex-related difference in risk arising from physical inactivity is mixed with no clear association (Sindi et al, 2021) Diabetes Two studies with >85,000 (Lee et al, 2021) or >3000 (Verhagen et al, 2022) participants with type 2 diabetes established that during a 6 year follow-up period development of AD or accelerated cognitive decline was greater in women.…”

Assessing Risk Factors for Cognitive Decline Using Electronic Health Records: A Scoping Review

“…Other commonly used databases in the UK studies included the Clinical Practice Research Datalink (n=6) [34][35][36][37][38] and the Health Improvement Network (THIN) (n=4). [39][40][41] Additional countries of databases represented in this review included Australia (n=3), [42][43][44] China (n=3), [45][46][47] Denmark (n=3), 41,48,49 the Netherlands (n=3), 41,49,50 Taiwan (n=2), 51,52 Canada (n=2), 53,54 and Sweden (n=2). 55,56…”

“…ICD codes were the most prevalent, featuring in 81.3% (n=65) of the studies, followed by Read codes in 11.3% (n=9). In addition to these coding systems, several other methods were used to define the outcomes, including prescriptions for dementia medications, 18,45,47,54 cognitive function tests, 27,53,57 referencing the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), 50,58,59 conducting screening interviews, 43,57 and neuroimaging. 27…”

“…20,51,54,61,62 Hypoglycemia, a common complication of diabetes treatment, has also been identified as a risk factor. 34,45,57,63 Extensive research has been done on the relationship between blood pressure and ADRD using EHR data. Hypertension, 51,62,64,65 hypotension 49 and blood pressure variability 66 have all been shown to contribute to an increased risk for ADRD.…”