Healthy lifestyle and all‐cause and cause‐specific dementia in individuals with type 2 diabetes and the roles of diabetes duration and insulin use in UK Biobank cohort

Abstract

AimsTo examine the effect of a healthy lifestyle score derived from seven lifestyle factors recommended by the diabetes management guidelines on all‐cause and cause‐specific dementia in individuals with type 2 diabetes mellitus (T2DM), and how diabetes duration and insulin use status modify their association.Materials and MethodsThis study analysed data of 459 840 participants from the UK Biobank. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals for the association of an overall healthy lifestyle score with all‐cause and cause‐specific dementia of Alzheimer's disease, vascular dementia and non‐Alzheimer non‐vascular dementia.ResultsUsing diabetes‐free participants who scored 5‐7 as the reference group, in diabetes‐free participants, we observed higher healthy lifestyle score was related to lower risk of all‐cause and cause‐specific dementia. However, in people with T2DM, those scored 2‐3, 4 and 5‐7 all had around the two‐time risk of all‐cause dementia (HR: 2.20‐2.36), while those scored 0‐1 had over a three‐time risk (HR: 3.14, 95% confidence interval 2.34‐4.21). A dose‐response trend was observed with vascular dementia (each 2‐point increase: 0.75, 0.61‐0.93) and no significant association with Alzheimer's disease (0.95, 0.77‐1.16). The reduced risk of all‐cause and cause‐specific dementia with higher lifestyle score was observed in patients with a diabetes duration less than 10 years, or in patients with no insulin use.ConclusionIn people with T2DM, higher healthy lifestyle score was associated with lower risk of all‐cause dementia. Diabetes duration and insulin use moderated the association between healthy lifestyle score and risk of dementia.

Establishing the feasibility and preliminary efficacy of a health belief model based educational training program on health belief perceptions and dementia‐preventive behaviors in people with type 2 diabetes

“…Unfortunately, T2DM can result in diabetic complications that affect several major organs, particularly the heart, kidneys, and brain (Demir et al, 2021). Diabetic complications affecting the brain include an increased risk of all‐type dementia (ATD) (Gudala et al, 2013; Zhou et al, 2023) which is a progressively deteriorating syndrome associated with changes in a person's executive functions and behavior.…”

“…Since dementia has been reported to occur after suboptimal regulation of T2DM, several self‐management strategies for preventing diabetes‐related dementia have been reported, including maintaining good glucose control, drug adherence, and maintenance of healthy lifestyle (Hopkins et al, 2016; Zhou et al, 2023). Thus, improving personal health behavior may lead to positive effects on T2DM to prevent dementia complications.…”