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Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c.
Age Ageing. 2019 11 01; 48(6):838-844.AA

Abstract

BACKGROUND

although type 2 diabetes increases risk of dementia by 2-fold, whether optimizing glycemic level in late life can reduce risk of dementia remains uncertain. We examined if achieving the glycemic goal recommended by the American Diabetes Association (ADA) within a year was associated with lower risk of dementia in 6 years.

METHODS

in this population-based observational study, we examined 2246 community-living dementia-free Chinese older adults with type 2 diabetes who attended the Elderly Health Centres in Hong Kong at baseline and followed their HbA1c level and cognitive status for 6 years. In line with the ADA recommendation, we defined the glycemic goal as HbA1c < 7.5%. The study outcome was incident dementia in 6 years, diagnosed according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Clinical Dementia Rating of 1-3.

RESULTS

those with HbA1c ≥ 7.5% at baseline and HbA1c < 7.5% in 1 year were associated with higher rather than lower incidence of dementia, independent of severe hypoglycemia, glycemic variability and other health factors. Sensitivity analyses showed that a relative reduction of ≥10%, but not 5-10%, in HbA1c within a year was associated with higher incidence of dementia in those with high (≥8%) and moderate (6.5-7.9%) HbA1c at baseline.

CONCLUSION

a large reduction in HbA1c could be a potential predictor and possibly a risk factor for dementia in older adults with type 2 diabetes. Our findings suggest that optimizing or intensifying glycemic control in this population requires caution.

Authors+Show Affiliations

Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.MRC Unit for Lifelong Health and Ageing at UCL, London, UK.Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.Department of Health, Elderly Health Service, The Government of Hong Kong SAR, Hong Kong SAR, China.Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31574142

Citation

Lee, Allen T C., et al. "Higher Dementia Incidence in Older Adults With Type 2 Diabetes and Large Reduction in HbA1c." Age and Ageing, vol. 48, no. 6, 2019, pp. 838-844.
Lee ATC, Richards M, Chan WC, et al. Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c. Age Ageing. 2019;48(6):838-844.
Lee, A. T. C., Richards, M., Chan, W. C., Chiu, H. F. K., Lee, R. S. Y., & Lam, L. C. W. (2019). Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c. Age and Ageing, 48(6), 838-844. https://doi.org/10.1093/ageing/afz108
Lee ATC, et al. Higher Dementia Incidence in Older Adults With Type 2 Diabetes and Large Reduction in HbA1c. Age Ageing. 2019 11 1;48(6):838-844. PubMed PMID: 31574142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c. AU - Lee,Allen T C, AU - Richards,Marcus, AU - Chan,Wai C, AU - Chiu,Helen F K, AU - Lee,Ruby S Y, AU - Lam,Linda C W, PY - 2019/03/14/received PY - 2019/07/14/revised PY - 2019/07/29/accepted PY - 2019/10/2/pubmed PY - 2020/9/1/medline PY - 2019/10/2/entrez KW - dementia KW - glycemic changes KW - older adults KW - type 2 diabetes SP - 838 EP - 844 JF - Age and ageing JO - Age Ageing VL - 48 IS - 6 N2 - BACKGROUND: although type 2 diabetes increases risk of dementia by 2-fold, whether optimizing glycemic level in late life can reduce risk of dementia remains uncertain. We examined if achieving the glycemic goal recommended by the American Diabetes Association (ADA) within a year was associated with lower risk of dementia in 6 years. METHODS: in this population-based observational study, we examined 2246 community-living dementia-free Chinese older adults with type 2 diabetes who attended the Elderly Health Centres in Hong Kong at baseline and followed their HbA1c level and cognitive status for 6 years. In line with the ADA recommendation, we defined the glycemic goal as HbA1c < 7.5%. The study outcome was incident dementia in 6 years, diagnosed according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Clinical Dementia Rating of 1-3. RESULTS: those with HbA1c ≥ 7.5% at baseline and HbA1c < 7.5% in 1 year were associated with higher rather than lower incidence of dementia, independent of severe hypoglycemia, glycemic variability and other health factors. Sensitivity analyses showed that a relative reduction of ≥10%, but not 5-10%, in HbA1c within a year was associated with higher incidence of dementia in those with high (≥8%) and moderate (6.5-7.9%) HbA1c at baseline. CONCLUSION: a large reduction in HbA1c could be a potential predictor and possibly a risk factor for dementia in older adults with type 2 diabetes. Our findings suggest that optimizing or intensifying glycemic control in this population requires caution. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/31574142/Higher_dementia_incidence_in_older_adults_with_type_2_diabetes_and_large_reduction_in_HbA1c_ DB - PRIME DP - Unbound Medicine ER -