Potential impact of diabetes prevention on mortality and future burden of dementia and disability: a modelling study

Abstract

Aims/hypothesisDiabetes is associated with an increased risk of dementia. We estimated the potential impact of trends in diabetes prevalence upon mortality and the future burden of dementia and disability in England and Wales.MethodsWe used a probabilistic multi-state, open cohort Markov model to integrate observed trends in diabetes, cardiovascular disease and dementia to forecast the occurrence of disability and dementia up to the year 2060. Model input data were taken from the English Longitudinal Study of Ageing, Office for National Statistics vital data and published effect estimates for health-state transition probabilities. The baseline scenario corresponded to recent trends in obesity: a 26% increase in the number of people with diabetes by 2060. This scenario was evaluated against three alternative projected trends in diabetes: increases of 49%, 20% and 7%.ResultsOur results suggest that changes in the trend in diabetes prevalence will lead to changes in mortality and incidence of dementia and disability, which will become visible after 10–15 years. If the relative prevalence of diabetes increases 49% by 2060, expected additional deaths would be approximately 255,000 (95% uncertainty interval [UI] 236,000–272,200), with 85,900 (71,500–101,600) cumulative additional cases of dementia and 104,900 (85,900–125,400) additional cases of disability. With a smaller relative increase in diabetes prevalence (7% increase by 2060), we estimated 222,200 (205,700–237,300) fewer deaths, and 77,000 (64,300–90,800) and 93,300 (76,700–111,400) fewer additional cases of dementia and disability, respectively, than the baseline case of a 26% increase in diabetes.Conclusions/interpretationReducing the burden of diabetes could result in substantial reductions in the incidence of dementia and disability over the medium to long term.Electronic supplementary materialThe online version of this article (10.1007/s00125-019-05015-4) contains peer-reviewed but unedited supplementary supplementary material, which is available to authorised users.

Indicators of dementia disease progression in primary care: An electronic health record cohort study

“…A record of a marker such as psychosis within the Severe Neuropsychiatric domain increased risk of all outcomes, concordant with a previously identified link of behavioural and psychological symptoms and/or antipsychotic use with risk of hospitalisation, nursing home admission, and mortality [28–31]. The Increased Multimorbidity, Comorbidity, and Symptoms domains were commonly recorded and strongly associated with the outcomes, supporting reviews showing increases in comorbidity and health‐related burden related to poor dementia outcomes [30,32,33]. The Care domain showed associations across all outcomes; research shows that caregiver coping and stress is associated with poor outcomes in the person with dementia [30,34], but also will be reflective of increased provision of care as demonstrated by the strong association with palliative care.…”

“…This study aimed to determine the validity of markers and domains as indicators of progression, and not as independent predictors of poor outcome. As such, some of the associations identified with long‐term outcomes may have arisen through chance given the multiple testing, and there may be other factors predictive of poor outcome, including socioeconomic status, ethnicity, social support, and social care provision [24,30,32,33,48,49], and measures obtainable by invasive testing such as pathogen presence (e.g., cerebrospinal fluid t‐tau) and cortical atrophy (volumetric magnetic resonance imaging). Future prognostic research should assess which domains improve prediction of long‐term outcomes when added to other factors.…”

“…Although there was variation in their prevalence and incidence, all domains had evidence of regular recording in primary care. However, some individual markers were infrequently recorded and use of these dementia outcomes [30,32,33]. The Care domain showed associations across all outcomes; research shows that caregiver coping and stress is associated with poor outcomes in the person with dementia [30,34], but also will be reflective of increased provision of care as demonstrated by the strong association with palliative care.…”

Brain Metabolism Alterations in Type 2 Diabetes: What Did We Learn From Diet-Induced Diabetes Models?

“…Dietary imbalances may trigger metabolic disorders and obesity, which in the long-term may progress to insulin resistance and T2D. Clinical studies set obesity and associated metabolic derangements as important risk factors for dementia (Pedditzi et al, 2016;Singh-Manoux et al, 2018;Bandosz et al, 2020). Li et al (2017) observed that cortical Aβ deposition by [ 18 F]-florbetapir PET was decreased in T2D patients while Aβ levels increased in the cerebral spinal fluid.…”

Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users

“…However, other preventable NCDs generally have longer latency. 176,177 Therefore, the full benefit of increased Health Check interventions might only be realised beyond the 20 years horizon set in our simulations, and further preventative actions at individual and population level might be needed.…”