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