Association of peripheral neuropathy with dementia in type 2 diabetes: a 5-year follow-up study using the national health insurance service-national health information database.

OBJECTIVE

To investigate whether the incidence of dementia is associated with diabetic peripheral neuropathy (DPN) in type 2 diabetes.

METHODS

Using the National Health Insurance Service-National Health Information Database, we calculated the incidence of various types of dementia according to type 2 diabetes with or without DPN by applying multivariate Cox regression analysis. Propensity score matching was performed to equalize each group by considering demographic characteristics and underlying conditions.

RESULTS

The incidence of various types of dementia was higher in patients with type 2 diabetes than in those without diabetes. The risk of developing dementia was higher in type 2 diabetes with DPN than in type 2 diabetes without DPN, irrespective of dementia type (all dementia: 1.53 vs. 2.1 vs. 1.4, P < 0.05, Alzheimer's disease: 1.46 vs. 1.98 vs. 1.34, P < 0.05, vascular dementia: 1.86 vs. 2.75 vs. 1.66, P < 0.05, other dementia: 1.62 vs. 2.19 vs. 1.48, P < 0.05; all type 2 diabetes vs. type 2 diabetes with DPN vs. type 2 diabetes without DPN compared with non-diabetes). When sodium-glucose cotransporter-2 inhibitors (SGLT2Is) were used, the incidence of all dementia types was lower in patients with type 2 diabetes than in patients with type 2 diabetes who did not use SGLT2Is although the incidence showed more decreased trend when dipeptidyl peptidase IV inhibitor (DPPIVI) was combined (all dementia: 0.51-0.71, P < 0.05, Alzheimer's disease: 0.78-0.80, P < 0.05, vascular dementia: 0.28-0.35, P < 0.05, other dementia: 0.2-0.70, P < 0.05; SGLT2Is user vs. neither SGLT2I nor DPPIVI). This pattern was also observed in patients with type 2 diabetes and DPN (all dementia: 0.32-0.56, P < 0.05, Alzheimer's disease: 0.44-0.55, P < 0.05, vascular dementia: 0.33, P < 0.05, other dementia: 0.53, P < 0.05; SGLT2Is user vs. neither SGLT2I nor DPPIVI).

CONCLUSIONS

More active diagnostic and prevention efforts are needed to address the risk of developing all forms of dementia, including vascular dementia, in patients with diabetes and DPN.