Glycemic and blood pressure variability and risk of developing dementia in diabetic patients

• Project/Area Number: 17K18278
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Epidemiology and preventive medicine; General internal medicine(including psychosomatic medicine)
• Research Institution: Tokyo Medical University (2018-2022); Hyogo Medical University (2017)
• Principal Investigator: MATSUMOTO CHISA 東京医科大学, 医学部, 講師 (30433923)
• Project Period (FY): 2017-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2019: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2017: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 認知症 / 血圧変動性 / 血糖変動性 / アスピリン / 糖尿病 / 高血圧 / 疫学 / 予防医学 / 疫学研究 / 予防 / 変動性

Outline of Final Research Achievements

The variability in glycemic control (HbA1c) and blood pressure (BP, systolic and diastolic) were examined by calculating the standard deviation and the coefficient of variation for each metric. Cox proportional hazards model was used to evaluate the association of BP / glycemic variability and risk of dementia. The variability in systolic BP was significantly associated with increased risk of dementia, even after adjustment for conventional dementia risk factors. Conversely, the variability in diastolic BP was not significantly associated with risk of dementia. As for the glycemic variability, the univariate analysis did not show any significant association. However, multivariate model revealed the significant association of glycemic variability and increased risk of dementia.
For the association of medication and risk of dementia, low-dose aspirin was significantly associated with lower risk of dementia only in female patients with type 2 diabetes.

Academic Significance and Societal Importance of the Research Achievements

本邦において急増している認知症は、健康寿命の延伸を阻害し国民医療費を圧迫しており、その発症予防は喫緊の課題である。一方、認知症と同様に糖尿病は増加傾向を認めているが、糖尿病患者では認知症発症リスクが高いことから、ハイリスク集団である糖尿病患者における認知症予防は極めて重要である。２型糖尿病患者の認知症予防では、血糖管理および血圧管理が有効であると考えられるが、血糖及び血圧の実値そのものだけではなく、その変動性管理が認知症予防において有用かを検証した報告はなかった。また低用量アスピリンによる認知症予防効果を示唆した報告もなかった。本研究成果は認知症予防に極めて有用なエビデンスを提供したと考える。

Research Products

• [Journal Article] Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial. (2020)
  • Author(s): Matsumoto C, Ogawa H, Saito Y, Okada S, Soejima H, Sakuma M, Masuda I, Nakayama M, Doi N, Jinnouchi H, Waki M, Morimoto T; JPAD Trial Investigators; JPAD Trial Investigators
  • Journal Title: Diabetes Care Volume: 42 Issue: 2 Pages: 314-320
  • DOI: 10.2337/dc19-1188
  • Peer Reviewed / Open Access
• [Presentation] The association of visit-to-visit blood pressure and blood glucose variability and incidence of dementia among patients with type 2 diabetes mellitus: Insights from the JPAD2 cohort study (2018)
  • Author(s): Chisa Matsumoto, Hisao Ogawa, Yoshihiko Saito, Sadanori Okada, Hirofumi Soejima, Mio Sakuma, Izuru Masuda, Masafumi Nakayama, Naofumi Doi, Hideaki Jinnouchi, Masako Waki, Takeshi Morimoto and the JPAD trial investigators
  • Organizer: American Heart Association Scientific Sessions 2018
  • Int'l Joint Research