Diabetes Metab J.  2020 Feb;44(1):113-124. 10.4093/dmj.2018.0216.

Incidence and Risk Factors for Dementia in Type 2 Diabetes Mellitus: A Nationwide Population-Based Study in Korea

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea. nhkendo@gmail.com
  • 2Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. ksmpdh@korea.ac.kr
  • 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 6Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.


Diabetes mellitus is associated with an increased risk of dementia. We aimed to comprehensively analyze the incidence and risk factors for dementia and young-onset dementia (YOD) in diabetic patients in Korea using the National Health Insurance Service data.
Between January 1, 2009 and December 31, 2012, a total of 1,917,702 participants with diabetes were included and followed until the date of dementia diagnosis or until December 31, 2015. We evaluated the incidence and risk factors for all dementia, Alzheimer's disease (AD), and vascular dementia (VaD) by Cox proportional hazards analyses. We also compared the impact of risk factors on the occurrence of YOD and late-onset dementia (LOD).
During an average of 5.1 years of follow-up, the incidence of all types of dementia, AD, or VaD was 9.5, 6.8, and 1.3/1,000 person-years, respectively, in participants with diabetes. YOD comprised 4.8% of all dementia occurrence, and the ratio of AD/VaD was 2.1 for YOD compared with 5.5 for LOD. Current smokers and subjects with lower income, plasma glucose levels, body mass index (BMI), and subjects with hypertension, dyslipidemia, vascular complications, depression, and insulin treatment developed dementia more frequently. Vascular risk factors such as smoking, hypertension, and previous cardiovascular diseases were more strongly associated with the development of VaD than AD. Low BMI and a history of stroke or depression had a stronger influence on the development of YOD than LOD.
The optimal management of modifiable risk factors may be important for preventing dementia in subjects with diabetes mellitus.


Alzheimer disease; Dementia; Dementia, vascular; Diabetes mellitus, type 2; Risk factors

MeSH Terms

Alzheimer Disease
Blood Glucose
Body Mass Index
Cardiovascular Diseases
Dementia, Vascular
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Follow-Up Studies
National Health Programs
Risk Factors*


  • Fig. 1 Incidence rates of (A) all-cause dementia, (B) Alzheimer's disease (AD), and (C) vascular dementia (VaD) based on age group.

  • Fig. 2 Hazard ratios (HRs) for all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) based on (A) body mass index (BMI) or (B) waist circumference. Analyses were adjusted for age, sex, smoking, alcohol intake, exercise, income, plasma glucose concentration, duration of diabetes, dyslipidemia, hypertension, diabetic retinopathy, chronic kidney disease, stroke, ischemic heart disease, depression, number of oral hypoglycemic agents, and treatment with insulin.

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