Risk factors for developing dementia in type 2 diabetes mellitus patients with mild cognitive impairment

Figures & data

Figure 1 Study flow diagram.

Abbreviations: CT, computerized tomography; DM, diabetes mellitus; MMSE, Mini-Mental State Examination.

Table 1 Baseline characteristics of the patients

Number of patients	207
Age (years)a	58.00 (47.00–65.50)
Gender (male)b	110 (53.10%)
Diabetes duration (years)a	10.00 (8.00–13.00)
BMI (kg/m^2)c	28.00 (±5.175)
AC (cm)c	99.98 (±19.15)
Smokingb	64 (30.90%)
Alcoholb	44 (21.30%)
Fasting glycemia (mg/dL)a	129.00 (95.00–176.00)
Postprandial glycemia (mg/dL)a	164.50 (110.00–216.00)
HbA1c (%)a	8.20 (7.00–9.40)
Triglycerides (mg/dL)a	132.00 (97.00–195.50)
Total cholesterol (mg/dL)a	182.00 (153.00–215.00)
HDLc (mg/dL)a	43.00 (36.00–52.50)
LDLc (mg/dL)a	104.60 (77.30–135.00)
Non-HDLc (mg/dL)a	136.00 (107.00–170.00)
HBPb
Normal	56 (27.10%)
Prehypertension	7 (3.4%)
Hypertension stage I	66 (31.9%)
Hypertension stage II	78 (37.7%)
Diabetic polyneuropathyb	105 (50.7%)
Diabetic arteriopathyb
Intermittent claudication	6 (2.9%)
Rest pain	15 (7.2%)
Ischemic ulcers or gangrene	6 (2.9%)
Diabetic retinopathyb
Background retinopathy	9 (4.3%)
Preproliferative retinopathy	25 (12.1%)
Proliferative retinopathy	5 (2.4%)
Gall bladderb	41 (19.8%)
Pancreatitisb	8 (3.9%)
Cardiovascular diseaseb	86 (41.5%)
Chronic kidney diseaseb	67 (32.4%)
Strokeb	34 (16.4%)

Notes:

a Continuous variables (with non-Gaussian distribution) are indicated by their median (IQR).

b Categorical variables are presented by absolute frequency (percentage) in the sample.

c Continuous variables (with Gaussian distribution) are indicated by their mean (SD).

Abbreviations: AC, abdominal circumference; BMI, body mass index; DM, diabetes mellitus; HBP, high blood pressure; HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol.

Table 2 Comparison between groups: DM patients without MCI vs DM patients with MCI

	Without MCI	With MCI	P-value
Number of patients	120	87	Not applicable
Age (years)a	52.00 (45.00–61.00)	63.00 (57.00–71.00)	<0.001
Gender (male)b	55 (45.83%)	55 (63.22%)	0.013
Diabetes duration (years)a	9.00 (7.00–11.00)	11.00 (10.00–18.00)	<0.001
BMI (kg/m^2)a	28.00 (25.00–32.00)	29.00 (27.00–32.00)	0.168
AC (cm)a	97.00 (81.00–109.00)	90.00 (92.00–115.00)	0.019
Smokingb	46 (38.33%)	18 (20.68%)	0.007
Alcoholb	23 (19.17%)	21 (24.14%)	0.388
Fasting glycemia (mg/dL)a	124.00 (95.00–171.00)	135.00 (93.00–177.00)	0.774
Postprandial glycemia (mg/dL)a	150.00 (110.00–210.00)	180.00 (110.00–234.00)	0.081
HbA1c (%)a	8.10 (7.00–9.30)	8.30 (7.00–9.60)	0.506
Triglycerides (mg/dL)a	126.00 (95.00–172.00)	140.00 (109.00–242.00)	0.070
Total cholesterol (mg/dL)a	181.00 (152.00–218.00)	182.00 (153.00–215.00)	0.986
HDLc (mg/dL)a	44.00 (37.00–56.00)	41.00 (34.00–50.00)	0.177
LDLc (mg/dL)a	104.20 (74.60–135.00)	106.20 (80.20–135.60)	0.895
Non-HDLc (mg/dL)a	135.00 (102.00–172.00)	140.00 (112.00–170.00)	0.536
Hypertensionb	76 (63.33%)	75 (86.21%)	<0.001
Diabetic polyneuropathyb	57 (47.50%)	48 (55.17%)	0.276
Diabetic arteriopathyb	12 (10%)	15 (17.24%)	0.127
Diabetic retinopathyb	18 (15%)	21 (24.14%)	0.097
Gall bladderb	15 (12.5%)	26 (29.88%)	0.002
Pancreatitisb	4 (3.33%)	4 (4.60%)	0.641
Cardiovascular diseaseb	30 (25%)	56 (64.37%)	<0.001
Chronic kidney diseaseb	33 (27.5%)	34 (39.08%)	0.079
Strokeb	12 (10%)	22 (25.28%)	0.003

Notes:

a Continuous variables (with non-Gaussian distribution) are indicated by their median (IQR).

b Categorical variables are presented by percentage (absolute frequency) in the sample.

Abbreviations: AC, abdominal circumference; BMI, body mass index; DM, diabetes mellitus; HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol; MCI, mild cognitive impairment.

Table 3 Comparison between groups: DM patients with MCI who did not develop dementia vs DM patients with MCI who developed dementia

	Without dementia	With dementia	P-valuec
Number of patients	64	23	Not applicable
Age (years)a	60.00 (54.00–65.00)	72.00 (69.00–76.00)	<0.001
Gender (male)b	40 (62.50%)	15 (65.21%)	0.817
Diabetes duration (years)a	11.00 (9.00–11.50)	29.00 (22.00–31.00)	<0.001
BMI (kg/m^2)a	30.50 (27.00–33.00)	27.50 (25.50–29.00)	0.009
AC (cm)a	108.00 (97.00–117.00)	94.00 (85.00–107.50)	0.011
Smokingb	16 (25%)	2 (8.7%)	0.098
Alcoholb	18 (28.12%)	3 (13.04%)	0.147
Fasting glycemia (mg/dL)a	129.00 (87.00–175.00)	166.00 (122.00–186.50)	0.041
Postprandial glycemia (mg/dL)a	173.00 (87.00–175.00)	189.00 (153.00–249.00)	0.182
HbA1c (%)a	8.45 (7.00–9.80)	7.90 (7.10–9.10)	0.400
Triglycerides (mg/dL)a	140.00 (110.00–242.00)	137.00 (94.50–244.00)	0.593
Total cholesterol (mg/dL)a	182.00 (153.00–211.00)	194.00 (164.00–241.50)	0.240
HDLc (mg/dL)a	40.00 (34.00–52.00)	43.00 (35.00–49.00)	0.950
LDLc (mg/dL)a	101.70 (79.40–125.00)	115.20 (94.60–149.50)	0.045
Non-HDLc (mg/dL)a	137.00 (108.00–166.00)	140.00 (124.50–193.00)	0.147
Hypertensionb	54 (84.3%)	21 (91.3%)	0.408
Diabetic polyneuropathyb	34 (53.12%)	14 (60.86%)	0.522
Diabetic arteriopathyb	9 (14.06%)	6 (26.08%)	0.190
Diabetic retinopathyb	18 (28.12%)	3 (13.04%)	0.147
Gall bladderb	19 (29.68%)	7 (30.43%)	0.946
Pancreatitisb	4 (6.25%)	0 (0%)	0.220
Cardiovascular diseaseb	33 (51.56%)	23 (100%)	,0.001
Chronic kidney diseaseb	24 (37.5%)	10 (43.47%)	0.614
Strokeb	11 (17.19%)	11 (47.83%)	0.004

Notes:

a Continuous variables (with non-Gaussian distribution) are indicated by their median (IQR).

b Categorical variables are presented by absolute frequency (percentage) in the sample.

c P-value was computed using Mann–Whitney U test for continuous variables (with non-Gaussian distribution) and Pearson’s chi-squared test for nominal variables.

Abbreviations: AC, abdominal circumference; BMI, body mass index; DM, diabetes mellitus; HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol; MCI, mild cognitive impairment.

Figure 2 Multivariate risk analysis for developing dementia in T2DM patients with MCI. The risk is expressed per 1 percentage point increase for HbA1c, and 1 mg/dL point increase for fasting glycemia, postprandial glycemia, triglycerides, HDLc, and LDLc. For stroke events, and cardiovascular disease, the risk is expressed as dichotomous variables.

Abbreviations: HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol; MCI, mild cognitive impairment; T2DM, type 2 diabetes mellitus.

Table 4 Predictors of developing dementia in patients with DM and cognitive impairment (multivariate logistic regression model; Nagelkerke R²=0.689)

Predictor variable	OR	95% CI
		Lower	Upper
Age (years)	0.956	0.885	1.033
Diabetes duration (years)*	1.542	1.268	1.875
Fasting glycemia (mg/dL)*	1.019	1.002	1.035
Postprandial glycemia (mg/dL)	1.008	0.990	1.026
HbA1c (%)*	0.387	0.257	0.450
Triglycerides (mg/dL)	0.984	0.966	1.002
HDLc (mg/dL)*	0.922	0.854	0.997
LDLc (mg/dL)*	1.018	1.004	1.039
Strokea,*	1.523	1.401	1.704
Cardiovascular disease	1.258	1.103	1.347

Notes:

a Presence of at least one stroke event.

* Predictor variable is significant both independently and as a cofactor.

Abbreviations: DM, diabetes mellitus; HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol.