title: Progress of Diabetic Severity and Risk of Dementia.
abstract: BACKGROUND
  Diabetes is a risk factor for dementia, but the effects of diabetic severity on dementia are unclear.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the association between the severity and progress of diabetes and the risk of dementia.
  
  
  METHODS
  We conducted a 12-year population-based cohort study of new-onset diabetic patients from the Taiwan National Health Insurance Research Database. The diabetic severity was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) from the prediabetic period to the end of follow-up. Cox proportional hazard regressions were used to calculate the hazard ratios (HRs) of the scores and change in the aDCSI.
  
  
  METHODS
  Participants were 431,178 new-onset diabetic patients who were older than 50 years and had to receive antidiabetic medications.
  
  
  RESULTS
  Dementia cases were identified by International Classification of Diseases, ninth revision, code (International Classification of Diseases, ninth revision, codes 290.0, 290.1, 290.2, 290.3, 290.4, 294.1, 331.0), and the date of the initial dementia diagnosis was used as the index date.
  
  
  RESULTS
  The scores and change in the aDCSI were associated with the risk of dementia when adjusting for patient factors, comorbidity, antidiabetic drugs, and drug adherence. At the end of the follow-up, the risks for dementia were 1.04, 1.40, 1.54, and 1.70 (P < .001 for trend) in patients with an aDCSI score of 1, 2, 3, and greater than 3, respectively. Compared with the mildly progressive patients, the adjusted HRs increased as the aDCSI increased (2 y HRs: 1.30, 1.53, and 1.97; final HRs: 2.38, 6.95, and 24.0 with the change in the aDCSI score per year: 0.51-1.00, 1.01-2.00, and > 2.00 vs < 0.50 with P < .001 for trend).
  
  
  CONCLUSIONS
  The diabetic severity and progression reflected the risk of dementia, and the early change in the aDCSI could predict the risk of dementia in new-onset diabetic patients.
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Chiu
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Wen-Chao
authors.initials: WC
authors.lastname: Ho
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Ding-Lieh
authors.initials: DL
authors.lastname: Liao
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Meng-Hung
authors.initials: MH
authors.lastname: Lin
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chiu
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Su
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene (W.-C.C., D.-L.L., P.-C.C.), and Department of Public Health (P.-C.C.), College of Public Health, National Taiwan University, Taipei 10055, Taiwan; Department of Psychiatry (W.-C.C., Y.-P.S.), Cathay General Hospital, Taipei 10630, Taiwan; School of Medicine (W.-C.C., Y.-P.S.), Fu Jen Catholic University, Taipei 24205, Taiwan; Department of Public Health (W.-C.H., M.-H.L.), China Medical University, Taichung 40402, Taiwan; Department of Addiction Psychiatry (D.-L.L.), Bali Psychiatric Center, New Taipei City 24936, Taiwan; Department of Psychiatry (C.-C.C.), Taipei City Psychiatric Center, Taipei City Hospital, 11080 Taipei, Taiwan; Department of Psychiatry (C.-C.C.), School of Medicine, Taipei Medical University, 110 Taipei, Taiwan; and Department of Environmental and Occupational Medicine (P.-C.C.), National Taiwan University College of Medicine and Hospital, Taipei 10051, Taiwan.
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D048909:Diabetes Complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents