Glycated Hemoglobin A1c Levels and Dementia Risk in Older Diabetics: A New Perspective
Individuals with diabetes commonly experience Alzheimer's disease and related dementias (ADRD). Factors such as hypoglycemia, hyperglycemia, and glycemic variability have been associated with increased risk of ADRD. Traditional glycemic measures, such as mean glycated hemoglobin A1c (HbA1c), may not identify the dynamic and complex pathophysiologic factors in the association between diabetes and ADRD.
The HbA1c time in range (TIR) is a previously developed measure of glycemic control that expresses HbA1c stability over time within specific ranges. This measure may inform the current understanding of the association between glucose levels over time and ADRD incidence.
Therefore, the present study was conducted to examine the association between HbA1c time in range and incidence of ADRD in older veterans with diabetes.
The study sample for this cohort study was obtained from administrative and health care utilization data. Participants were required to have at least 4 HbA1c tests during the 3-year baseline period.
The study included 374 021 veterans with diabetes. During follow-up of up to 10 years, 11% developed ADRD. Furthermore, the direction of out-of-range HbA1c levels was associated with incident ADRD. Having greater time below range was associated with significantly increased risk.
Hence, it was concluded that in this study of older adults with diabetes, increased HbA1c stability within patient-specific target ranges was associated with a lower risk of ADRD. Lower HbA1c TIR may identify patients at increased risk of ADRD.
Ref: Underwood PC, Zhang L, Mohr DC, et al. Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes. JAMA Netw Open. 2024;7(8):e2425354. doi:10.1001/jamanetworkopen.2024.25354
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