Journal of Diabetes and its Complications ( IF 3 ) Pub Date : 2023-09-04 , DOI: 10.1016/j.jdiacomp.2023.108598 Chun-Kwan O 1 , Brian Wai-Hei Siu 1 , Vanessa Wai-Shan Leung 1 , Yuan-Yuan Lin 2 , Chen-Zhao Ding 1 , Eric Siu-Him Lau 1 , Andrea On-Yan Luk 3 , Elaine Yee-Kwan Chow 3 , Ronald Ching-Wan Ma 3 , Juliana Chung-Ngor Chan 3 , Rachel Ngan-Yin Chan 4 , Yun Kwok Wing 4 , Alice Pik-Shan Kong 3
Aims
To examine the risk association of insomnia with incident chronic cognitive impairment in older adults with type 2 diabetes mellitus (T2D).
Methods
Between July 2010 and June 2015, patients with T2D aged ≥60 years enrolled in the Hong Kong Diabetes Register completed the Insomnia Severity Index (ISI) questionnaire. Patients were considered having insomnia if they had ISI score > 14. We prospectively followed up the cohort and censored outcome through reviewing diagnoses and clinical notes entered by attending physicians in electronic medical record to identify incident cases of mild cognitive impairment and dementia.
Results
After excluding shift workers and those with established chronic cognitive impairment at baseline, we included 986 patients with T2D in this study (58.3 % men, mean age ± standard deviation: 62.5 ± 2.6 years, disease duration of diabetes: 10.7 ± 8.2 years, HbA1c: 7.4 ± 1.3 %, insulin users: 28.7 %, insomnia: 9.1 %). After a median follow-up of 7.6 (interquartile range = 2.0) years, 41 (4.2 %) developed chronic cognitive impairment. Using Cox regression analysis, insomnia (hazard ratio, HR 2.909, p = 0.012) and HbA1c ≥ 7 % (HR 2.300, p = 0.038) were positively associated with incident chronic cognitive impairment while insulin use (HR 0.309, p = 0.028) showed negative association.
Conclusions
Insomnia, suboptimal glycemic control and non-insulin use are independent risk factors for incident chronic cognitive impairment in older adults with T2D.
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