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Type 2 diabetes as a risk factor for Alzheimer's disease: the confounders, interactions, and neuropathology associated with this relationship
Vagelatos NT, Eslick GD.. Epidemiologic reviews, 2013-01-11
Topic: Amyloid, tau and blood-test diagnosis
We performed a systematic review and meta-analysis to explore whether type 2 diabetes mellitus (T2DM) increases the risk of Alzheimer's disease (AD). We also reviewed interactions with smoking, hypertension, and apolipoprotein E ɛ4. Using a series of databases (MEDLINE, EMBASE, PubMed, Current Contents Connect, and Google Scholar), we identified a total of 15 epidemiologic studies. Fourteen studies reported positive associations, of which 9 were statistically significant. Risk estimates ranged from 0.83 to 2.45. The pooled adjusted risk ratio was 1.57 (95% confidence interval: 1.41, 1.75), with a population-attributable risk of 8%. Smoking and hypertension, when comorbid with T2DM, had odds of 14 and 3, respectively. Of the 5 studies that investigated the interaction between T2DM and apolipoprotein E ɛ4, 4 showed positive associations, of which 3 were significant, with odds ranging from 2.4 to 4.99. The pooled adjusted risk ratio was 2.91 (95% confidence interval: 1.51, 5.61). Risk estimates were presented in the context of a key confounder-cerebral infarcts-which are more common in those with T2DM and might contribute to the manifestation of clinical AD. We provide evidence from clinico-neuropathologic studies that demonstrates the following: First, cerebral infarcts are more common than AD-type pathology in those with T2DM and dementia. Second, those with dementia at postmortem are more likely to have both AD-type and cerebrovascular pathologies. Finally, cerebral infarcts reduce the number of AD lesions required for the manifestation of clinical dementia, but they do not appear to interact synergistically with AD-type pathology. Therefore, the increased risk of clinically diagnosed AD seems to be mediated through cerebrovascular pathology.
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APA 7th
Vagelatos, N. T., & Eslick, G. D. (2013). Type 2 diabetes as a risk factor for Alzheimer's disease: the confounders, interactions, and neuropathology associated with this relationship. Epidemiologic reviews. https://doi.org/10.1093/epirev/mxs012
Vancouver
Vagelatos NT, Eslick GD. Type 2 diabetes as a risk factor for Alzheimer's disease: the confounders, interactions, and neuropathology associated with this relationship. Epidemiologic reviews. 2013. doi:10.1093/epirev/mxs012. PMID: 23314404.
BibTeX
@article{vagelatos2013-23314404,
author = {Vagelatos, N. T. and Eslick, G. D.},
title = {{Type 2 diabetes as a risk factor for Alzheimer's disease: the confounders, interactions, and neuropathology associated with this relationship}},
journal = {Epidemiologic reviews},
year = {2013},
doi = {10.1093/epirev/mxs012},
pmid = {23314404},
url = {https://doi.org/10.1093/epirev/mxs012}
}
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Key findings
- Fourteen studies reported positive associations, of which 9 were statistically significant.
- Of the 5 studies that investigated the interaction between T2DM and apolipoprotein E ɛ4, 4 showed positive associations, of which 3 were significant, with odds ranging from 2.4 to 4.99.
- Therefore, the increased risk of clinically diagnosed AD seems to be mediated through cerebrovascular pathology.
Why it matters
This systematic review and meta-analysis found that type 2 diabetes was associated with an increased risk of Alzheimer's disease, with a pooled adjusted risk ratio of 1.57, and that the increased risk seemed to be mediated through cerebrovascular pathology such as cerebral infarcts. It identifies diabetes as a risk factor but does not show that treating diabetes prevents or cures Alzheimer's disease.
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Study details
- Study designsystematic review
- Participants15
- Evidence strengthHigh
How this study scored 68/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Epidemiologic reviews) |
| Journal's citation record | 2 / 4 | Epidemiologic Reviews: journal h-index 178 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 1 / 4 | 15 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 6 / 7 | Cited 320 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 21.3 citations a year over 15 year(s) since 2013 |
| Impact for its field and year | 4 / 6 | Cited 17.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 24 other studies in this library |
| Still being cited | 3 / 4 | Cited 58 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Guy D. Eslick: h-index 72 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | The University of Sydney: institution h-index 1,466 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23314404) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 68 / 100 | — |
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Read the original
- DOI: 10.1093/epirev/mxs012
- PubMed: 23314404
- Original source →
- Free full text: Epidemiologic Reviews →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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