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Impaired Insulin Secretion Tied to Alzheimer’s Risk

Impaired insulin response in midlife is associated with an increased risk of developing Alzheimer’s disease (AD) up to 35 years later, Swedish researchers report. "It is difficult to directly translate these results to practical advice for individual patients," lead investigator Dr. Elina Ronnemaa stated. However, she added, "future research will show, for example, how the new antidiabetic drugs may affect even the brain."

Dr. Ronnemaa and colleagues at Uppsala University examined the relationship between insulin response at the age of 50 years and AD onset in 2322 men participating in a population-based study.

During a median follow-up of 32 years, 394 of the subjects were diagnosed with any type of dementia or cognitive impairment; among them, 102 had AD and 57 had vascular dementia.

Low insulin response at baseline was associated with a hazard ratio for AD of 1.31 for each 1 SD decrease. The increased risk remained after adjusting for age, body mass index and insulin resistance. The association was stronger in those with the APOE e4 allele (hazard ratio, 2.62).

Each 1 SD decrease in glucose tolerance increased the hazard ratio for vascular dementia (but not AD) by 1.45. The APOE e4 genotype did not affect the risk of vascular dementia.

"Together," the researchers conclude, "these data emphasize the importance of insulin, both acute and long-term exposure, in normal brain function."

Neurology 2008;71:1065-1071.

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FACT:  
Patients with new hyperglycemia have significantly increased hospital mortality compared with patients with known diabetes: . Hyperglycemia is common in hospitalized patients with and without diabetes. It has long been thought of as an adaptive mechanism and in the intensive care setting is rarely treated below a threshold value of 225-250 mg/dL  Elevated blood glucose concentrations are associated with increased morbidity and mortality after burns, surgery, stroke, myocardial infarction and head trauma.  Hyperglycemia is believed to increase infarct size in both MI and stroke  Length of stay is higher for the new hyperglycemic group. Better outcomes were demonstrated in patients with fasting and admission blood glucose < 126 mg/dL and all random blood glucose levels < 200 mg/dL    

Circulation. 1999;99:2626-2632.