Meta-analysis:The Relationship Between Hypoglycemia And Cognitive Dysfunction In Patients With Diabetes Mellitus

BACKGROUNDDiabetes is a worldwide disease.The number of diabetes patients in China is the largest in the world.Diabetes-related cognitive dysfunction is one of the complications of the disease,and is paid by more and more attention in clinical work.Hypoglycemia often happens in patients with long duration of diabetes and treated with sulfonylureas and insulin therapy,there are domestic and foreign studies have proved that hypoglycemia is a risk factor for cognitive dysfunction in diabetic patients,but some other studies have found that there is no clear correlation between these two syndromes.In our study,a Meta-analysis method is used to explore the relationship between hypoglycemia and cognitive dysfunction,which provides reference for the prevention and control of cognitive function in clinical work.METHODSA systematic search was conducted in the database of Pubmed,Embase,Cochrane Library,Ovid,CNKI,Wanfang database and Sinomed,the cut-off date was May 2018.The literature was collected researches studying the relationship between hypoglycemia and cognitive impairment in diabetic patients.Search,data extraction and quality assessment were completed independently by two researchers in accordance with the established literature retrieval strategy.95%confidential interval(CI)were calculated.Heterogeneity was measured by the Cochran Q and I2 statistic:for the Q statistic,a p value of<0.1 was considered statistically significant.As for I2,a value for>50%was considered significant.If heterogeneity exists,a random effects model was chosen.According to the previously defined subgroup(the yellow race,the other races),we analysed the relationship of hypoglycemia and cognitive dysfunction,The Egger's test was used to evaluate the publication bias,and Galbraith was used to explore the high heterogeneity of the literature.RESULTSA total of 12 case-control studies and 1 cohort study were included for a meta-analysis(n=206654).All patients in the group met the 2009 ADA diabetes diagnostic criteria and the diagnostic criteria for cognitive impairment(scale score met or received medication).The results showed that:in diabetic patients,hypoglycemia is associated with cognitive dysfunction(z = 4.81,P<0.001),people with hypoglycemia may have higher risk of cognitive dysfunction than those free from hypoglycemia(OR = 1.744,95%Cl:1.391 2.188)both in the yellow race and the other races.There was no publication bias and the results were stable and reliable.CONCLUSIONHypoglycemia in diabetic patients is associated with cognitive impairment,and the risk of cognitive dysfunction is higher in patients with hypoglycemia.