TY  - JOUR
VL  - 48
Y1  - 2019/11//
TI  - Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c
IS  - 6
KW  - dementia
KW  -  glycemic changes
KW  -  older adults
KW  -  type 2 diabetes
A1  - Lee, ATC
A1  - Richards, M
A1  - Chan, WC
A1  - Chiu, HFK
A1  - Lee, RSY
A1  - Lam, LCW
EP  - 844
JF  - Age and Ageing
UR  - https://doi.org/10.1093/ageing/afz108
ID  - discovery10083145
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
AV  - public
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
SP  - 838
ER  -