Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial
AuthorGong, J; Harris, K; Hackett, M; Peters, SAE; Brodaty, H; Cooper, M; Hamet, P; Harrap, S; Mancia, G; MacMahon, S; ...
Source TitleDiabetes, Obesity and Metabolism: a journal of pharmacology and therapeutics
University of Melbourne Author/sHarrap, Stephen
Document TypeJournal Article
CitationsGong, J., Harris, K., Hackett, M., Peters, S. A. E., Brodaty, H., Cooper, M., Hamet, P., Harrap, S., Mancia, G., MacMahon, S., Chalmers, J. & Woodward, M. (2021). Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial. DIABETES OBESITY & METABOLISM, 23 (8), pp.1775-1785. https://doi.org/10.1111/dom.14391.
Access StatusAccess this item via the Open Access location
Open Access URLPublished version
AIM: To estimate the associations between risk factors and cognitive decline (CD)/dementia, and the sex differences in these risk factors in individuals with type 2 diabetes, while accounting for the competing risk of death. MATERIALS AND METHODS: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with type 2 diabetes was used to estimate the odds of CD/dementia using multinomial logistic regression. RESULTS: During a median 5-year follow-up, 1827 participants (43.2% women) had CD/dementia (1718 with CD only; 21 with dementia only; 88 with CD and dementia), and 929 (31.0% women) died without CD/dementia. Women had lower odds of CD/dementia than men (odds ratio [OR] [95% confidence interval], 0.88 [0.77, 1.00]); older age, higher total cholesterol, HbA1c, waist circumference, waist-to-height ratio, moderately increased albumin-creatinine ratio, stroke/transient ischaemic attack and retinal disease were each associated with greater odds of CD/dementia; higher years at education completion, baseline cognitive function, taller stature and current alcohol use were inversely associated. Higher waist circumference (women-to-men ratio of ORs [ROR], 1.05 [1.00, 1.10] per 5 cm) and presence of anxiety/depression (ROR, 1.28 [1.01, 1.63]) were associated with greater ORs for CD/dementia in women than men. CONCLUSIONS: Several risk factors were associated with CD/dementia. Higher waist circumference and mental health symptoms were more strongly associated with CD/dementia in women than men. Further studies should examine the mechanisms that underlie these sex differences.
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