title: Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study.
abstract: OBJECTIVE
  Most diabetes mellitus (DM) patients have several comorbidities; the correlation of these comorbidities with dementia in DM requires clarification.
  
  
  METHODS
  Using claims data from Taiwan National Health Insurance, we identified 33,709 DM adults before the year 2000 and randomly selected 67,066 non-DM patients matched by sex and age. Subjects were followed until diagnosis with dementia, excluded due to death/withdrawal from the insurance program, or followed until 2011. We compared the incidence and hazard ratio (HR) for dementia in both cohorts.
  
  
  RESULTS
  Comorbidities were more prevalent in DM patients, including hypertension, hyperlipidemia, stroke, coronary artery and/or kidney disease. The HR was higher for the DM cohort with comorbidities than those without: 1.88 vs. 1.46 with hypertension; 1.56 vs. 1.39 with hyperlipidemia; 1.73 vs. 1.37 with coronary artery disease; 2.36 vs. 2.29 with stroke and 1.88 vs. 1.50 with kidney disease. The HR for dementia in diabetics rose from 1.41 in those without comorbidities to 2.49 in those with ≥4 comorbidities. In the DM cohort, HR was 1.22 for non-insulin-users and 1.41 for insulin-users, and 1.49 for type 1 DM and 1.23 for type 2 DM.
  
  
  CONCLUSIONS
  Diabetic patients have an elevated risk of dementia, and comorbidity increases this risk.
authors.affiliation: Department of Nursing, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, New Taipei, 242, Taiwan; Department of Business Administration, Asia University, Taichung, 413, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: College of Medicine, China Medical University, Taichung, 404, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou, 540, Taiwan.
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Hung
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Department of Emergency Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou, 540, Taiwan. Electronic address: shihchan@gmail.com.
authors.forename: Shih-Chang
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Department of Emergency Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou, 540, Taiwan.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Liu
authors.affiliation: Department of Neurology, Nantou Hospital, Ministry of Health and Welfare, Nantou, 540, Taiwan.
authors.forename: Chia-Wei
authors.initials: CW
authors.lastname: Chang
authors.affiliation: College of Nursing, Central Taiwan University of Science and Technology, Taichung, 406, Taiwan.
authors.forename: Yueh-Juen
authors.initials: YJ
authors.lastname: Hwu
authors.affiliation: Department of Business Administration, Asia University, Taichung, 413, Taiwan.
authors.forename: Shieh-Liang
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.
authors.forename: Fung-Chung
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D048909:Diabetes Complications / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Comorbidity; Dementia; Epidemiology; Retrospective cohort; Risk