糖尿病用药与老年2型糖尿病患者认知功能的相关性研究

Study on the Correlation between Diabetes Medication and Cognitive Function in Elderly Patients with Type 2 Diabetes

摘要: 目的：探讨老年2型糖尿病患者不同降糖方案与多维度认知功能之间的相关性。方法：基于2011~2014年NHANES数据库，纳入647名60岁及以上的T2DM患者。通过CERAD即时与延迟回忆、动物流畅性及数字符号替代测试评估认知功能。采用t检验比较不同药物组间的认知z分数差异，并利用校正后的Logistic回归模型分析药物与各维度认知障碍的关联。结果：二甲双胍组在综合认知分数上显著优于不服药组(Mean Difference = 0.28, 95% CI: 0.10~0.46, P = 0.002)。在调整了混杂因素后的Logistic回归显示，二甲双胍可显著降低即时回忆障碍(OR = 0.29, 95% CI: 0.13~0.63)及综合认知功能障碍(OR = 0.33, 95% CI: 0.16~0.71)的风险。交互分析均未见统计学意义(P_interaction > 0.05)。结论：二甲双胍的使用与老年T2DM患者较低的认知障碍风险独立相关，其保护效应具有跨人群的一致性。

Abstract: Objective: To investigate the correlation between different hypoglycemic regimens and multidimensional cognitive function in elderly patients with Type 2 Diabetes Mellitus (T2DM). Methods: Based on the 2011-2014 National Health and Nutrition Examination Survey (NHANES) database, 647 T2DM patients aged 60 years and older were included. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) immediate and delayed recall tests, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Weighted t-tests were used to compare differences in cognitive z-scores between different medication groups, and adjusted logistic regression models were employed to analyze the association between medications and cognitive impairment in various dimensions. Results: The metformin group showed significantly better overall cognitive scores compared to the no-medication group (Mean Difference = 0.28, 95% CI: 0.10~0.46, P = 0.002). After adjusting for confounding factors, logistic regression indicated that metformin significantly reduced the risk of immediate recall impairment (OR = 0.29, 95% CI: 0.13~0.63) and overall cognitive impairment (OR = 0.33, 95% CI: 0.16~0.71). Interaction analyses showed no statistical significance (P_interaction > 0.05). Conclusion: The use of metformin is independently associated with a lower risk of cognitive impairment in elderly T2DM patients, with consistent protective effects across populations. This study highlights the potential neuroprotective benefits of metformin beyond glycemic control, providing evidence for clinical decision-making in balancing blood sugar management and cognitive preservation in older adults.