eprintid: 10083145 rev_number: 29 eprint_status: archive userid: 608 dir: disk0/10/08/31/45 datestamp: 2019-10-09 17:13:43 lastmod: 2021-12-13 01:50:21 status_changed: 2020-12-14 17:18:11 type: article metadata_visibility: show creators_name: Lee, ATC creators_name: Richards, M creators_name: Chan, WC creators_name: Chiu, HFK creators_name: Lee, RSY creators_name: Lam, LCW title: Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c ispublished: pub divisions: UCL divisions: B02 divisions: D14 divisions: GA3 divisions: G17 keywords: dementia, glycemic changes, older adults, type 2 diabetes note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. 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. date: 2019-11 date_type: published official_url: https://doi.org/10.1093/ageing/afz108 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1699982 doi: 10.1093/ageing/afz108 pii: 5579859 lyricists_name: Richards, Marcus lyricists_id: MRICH78 actors_name: Richards, Marcus actors_name: Pilling, Stephanie actors_id: MRICH78 actors_id: SARMS84 actors_role: owner actors_role: impersonator full_text_status: public publication: Age and Ageing volume: 48 number: 6 pagerange: 838-844 event_location: England issn: 1468-2834 citation: Lee, ATC; Richards, M; Chan, WC; Chiu, HFK; Lee, RSY; Lam, LCW; (2019) Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c. Age and Ageing , 48 (6) pp. 838-844. 10.1093/ageing/afz108 <https://doi.org/10.1093/ageing%2Fafz108>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10083145/3/Richards_Lee%20et%20al.%20diabetes%20and%20dementia%20final.pdf