Greater exposure to HBA1C concentrations greater than or equal to 9% was associated with the highest risk of dementia.
In this cohort study of 253 211 people 50 years or older with type 2 diabetes, those with a majority (& GT; 50 %) of glycosylated hemoglobin concentrations of 9 % or more had the greatest risk of dementia.
The results of this study support the recommendations of the common clinical guides for relaxed glycemic objectives in the elderly.
The glycemic control levels associated with the least risk of dementia in people with type 2 diabetes are unknown. This knowledge is essential to inform the establishment of patient -centered glycemic objectives.
target
Examine associations between accumulated exposure to several ranges of glucosylated hemoglobin concentrations (HBA 1C) with the risk of dementia between sexes and racial and ethnic groups and the association of current therapeutic glycemic objectives with the risk of dementia.
design, environment and participants
This Cohortes study included members of the Integrated Medical Care System of Kaiser permanent in northern California with type 2 diabetes that were 50 years or more during the study period from January 1, 1996 to September 30, 2015.
People with less than 2 HBA 1C measurements during the study period, dementia prevalent to the start of the study or less than 3 years of follow -up.The data were analyzed from February 2020 to January 2023.
exhibitions
Accumulated exposure updated to HBA 1C thresholds.In each HBA 1C measurement, the participants were classified according to the percentage of their HBA 1C measurements that fell into the following categories: less than 6 %, from 6 %to less than 7 %, from 7 %to less than 8 %,From 8 % to less than 9 %, from 9 % to less than 10 % and 10 % or more of total hemoglobin (to convert the percentage of total hemoglobin into a proportion of total hemoglobin, multiply by 0.01).
main results and measures
The dementia diagnosis was identified using the International Classification of Diseases, Codes of the Ninth Review of Encounters of Hospitalized and Ambulatory Patients.COX proportional risk regression models estimated the association of accumulated glycemic exposure variable over time with dementia, adjusting by age, race and ethnicity, initial health conditions and number of HBA 1C measurements.
results
A total of 253,211 participants were included.The average age (of) of the participants was 61.5 (9.4) years and 53.1 % were men.The average duration (of) of the follow -up was 5.9 (4.5) years.
Participants with more than 50 % of HBA 1C measurements at 9 % to less than 10 % or 10 % or more had a higher risk of dementia compared to those who had 50 % or less of the measurements in those categories(HBA 1C 9 %A & LT; 10 %: Fitting History Fit [AHR], 1.31 [95 %IC, 1.15-1,51]; HBA 1C ≥10 %: AHR, 1.74 [ic95 %, 1.62-1,86]).
On the contrary, participants with more than 50 % of HBA 1C concentrations below 6 %, from 6 % to less than 7 % or 7 % to less than 8 % had a lower risk of dementia (HBA 1C & LT; 6%: AHR, 0.92 [95 %CI, 0.88-0.97], HBA1C 6 %A&L 7 %: AHR, 0.79 [95 %CI, 0.77-0.81];HBA 1C 7 %A & LT; 8 %: AHR, 0.93 [95 %IC, 0.89-0.97]).
discussion
In this great sample of people with type 2 diabetes, we find that greater accumulated exposure to HBA1C concentrations in the 6 % range to less than 7 % and from 7 % to less than 8 % was associated with a lower risk of dementia.
It is important to highlight that noWe observe significant changes in the risk for people with HBA1C concentrations in the non -intensive glycemic control range recommended by the American Society of Geriatrics and the US veteran affairs department. UU. For older patients with multiple comorbilities, poor health orLimited life expectancy.
conclusions and relevance
In this cohort study of a large sample of older people with type 2 diabetes, we find that greater exposure to HBA1C concentrations greater than or equal to 9 % was associated with the highest risk of dementia.Additional work is needed to examine whether the observation associations that we inform are causal and are seen in other groups.
In this study, the risk of dementia was greater among adults with accumulated concentrations of HBA 1C of 9 % or more.These results support the relaxed glycemic objectives currently recommended for older people with type 2 diabetes.
