Table 1_Risk factors for mild cognitive impairment in type 2 diabetes: a systematic review and meta-analysis.docx

BackgroundMild Cognitive Impairment (MCI), a transition between normal aging and dementia, is linked to higher dementia risk and potential reversibility. Type 2 Diabetes Mellitus (T2DM), affecting over 537 million adults worldwide, increases susceptibility to MCI, with higher cognitive decline prevalence in diabetic populations. Previous meta-analyses focused on isolated factors, neglecting multidimensional interactions. This study synthesizes T2DM-MCI risk factors across clinical, lifestyle, and biochemical dimensions to support early identification and intervention of cognitive dysfunction in T2DM populations.
Materials and MethodsThis systematic review and meta-analysis, following PRISMA guidelines, searched five databases for articles published from January 1, 2014, to December 31, 2024. Studies were screened based on predefined criteria, with data extracted independently by two researchers. Quality was assessed using Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) tools. Data were analyzed using RevMan software, with odds ratio (OR) and 95% CI as effect size measures. Heterogeneity was assessed using I² statistics, and subgroup analyses were conducted for factors with ≥10 studies.
Results30 studies with 10,469 participants were included. Prevalence rate of MCI in T2DM was 44.1%. Significant associations were found between T2DM-MCI and age (OR = 1.06, P = 0.01), female sex (OR = 1.23, P = 0.05), diabetes duration (OR = 1.07, P = 0.03), education (OR = 0.82, P = 0.0001), smoking (OR = 1.44, P = 0.003), hypertension (OR = 2.25, P < 0.001), cardiovascular disease (CVD) (OR = 2.61, P < 0.001), glycated hemoglobin (HbA1c) (OR = 1.33, P = 0.001), and homeostasis model assessment of insulin resistance (HOMA-IR) (OR = 1.95, P = 0.02).
ConclusionThis meta-analysis identifies advanced age (≥60 years), female sex, prolonged Diabetes duration (8–9 years), elevated HbA1c (>9%), and low education (≤6 years) as key predictors of MCI in T2DM, with significant dose-response relationships. Vascular comorbidities, insulin resistance, and inflammatory markers further exacerbate risks. Clinical priorities include rigorous glycemic control (HbA1c <7%), targeted cognitive screening for high-risk subgroups, and multidisciplinary care for patients with microvascular complications. However most of the studies included in this study come from Chinese people, so the generalization of the results may be limited.
Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD420250637336.

背景：轻度认知障碍（Mild Cognitive Impairment, MCI）是正常衰老与痴呆之间的过渡阶段，与更高的痴呆发病风险及潜在可逆性相关。2型糖尿病（Type 2 Diabetes Mellitus, T2DM）目前影响全球超5.37亿成年人，会增加罹患轻度认知障碍的易感性，且糖尿病群体中认知衰退的患病率更高。既往荟萃分析多聚焦于单一孤立因素，忽略了多维度交互作用。本研究综合了临床、生活方式及生化维度下的2型糖尿病-轻度认知障碍相关危险因素，旨在为2型糖尿病群体的认知功能障碍早期识别与干预提供依据。
材料与方法：本研究遵循PRISMA指南开展系统综述与荟萃分析，检索了2014年1月1日至2024年12月31日期间发表于5个数据库的相关文献。研究依据预设标准进行文献筛选，由两名研究者独立提取数据。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale, NOS）及乔安娜·布里格斯研究所（Joanna Briggs Institute, JBI）工具评估研究质量。使用RevMan软件进行数据分析，以比值比（odds ratio, OR）及95%置信区间（95% CI）作为效应量指标。采用I²统计量评估异质性，对纳入≥10项研究的危险因素开展亚组分析。
结果：本研究最终纳入30项研究，共涉及10469名受试者。2型糖尿病群体中轻度认知障碍的患病率为44.1%。研究发现2型糖尿病-轻度认知障碍与以下因素存在显著关联：年龄（OR=1.06，P=0.01）、女性性别（OR=1.23，P=0.05）、糖尿病病程（OR=1.07，P=0.03）、受教育水平（OR=0.82，P=0.0001）、吸烟（OR=1.44，P=0.003）、高血压（OR=2.25，P<0.001）、心血管疾病（Cardiovascular Disease, CVD）（OR=2.61，P<0.001）、糖化血红蛋白（glycated hemoglobin, HbA1c）（OR=1.33，P=0.001）及胰岛素抵抗稳态模型评估（homeostasis model assessment of insulin resistance, HOMA-IR）（OR=1.95，P=0.02）。
结论：本荟萃分析明确了高龄（≥60岁）、女性性别、较长糖尿病病程（8~9年）、糖化血红蛋白水平升高（>9%）及低受教育水平（≤6年）为2型糖尿病患者罹患轻度认知障碍的关键预测因素，且存在显著的剂量-反应关系。血管合并症、胰岛素抵抗及炎症标志物会进一步加剧患病风险。临床干预优先级应包括严格的血糖控制（HbA1c<7%）、针对高危亚群的针对性认知筛查，以及对存在微血管并发症的患者开展多学科照护。但本研究纳入的多数研究对象为中国人群，因此研究结果的外推性或存在一定局限。
系统综述注册：https://www.crd.york.ac.uk/prospero，注册号：CRD420250637336