Tighter Glycemic Control in T2D Reduces Risk for All-Cause Dementia: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in JAMA Network Open that examined the association of receiving a multidisciplinary diabetes management program that enabled better glycemic control with subsequent risk of dementia incidence and the association of dementia with glycemic control.

The study

Researchers conducted the study by tapping electronic health care records for all individuals who used public health care services in Hong Kong from 2011 to 2019. Investigators identified all adults diagnosed with type 2 diabetes (T2D) in 2011, excluding those with type 1 diabetes, gestational diabetes, or pre-existing dementia. Researchers matched participants receiving a multidisciplinary, primary care management program called Risk Assessment and Management Program-Diabetes Mellitus (RAMP-DM) plus usual care in a 1:1 ratio with patients who received usual care only. Follow-up continued until occurrence of outcome events, death, or the study end in December 2019.

The primary outcome was dementia incidence and secondary outcomes included AD, VD, and other types of dementia. The primary analysis focused on RAMP-DM use and explored early-stage HbA1C levels after joining RAMP-DM in relation to dementia incidence.

The final cohort, after propensity score matching, numbered 55 618 participants; mean age was 62.28 years and 51.4% were women, and participants were divided equally between the RAMP-DM group and usual care, with 27 809 in each.

The findings

Compared with the usual care group, participants in the RAMP-DM group had a 28% lower risk of all-cause dementia, 15% lower risk of Alzheimer disease, 39% lower risk of vascular dementia, and 29% lower risk of other subtypes of dementia.

Study investigators also found that a "moderate glycemic control target" of between 6.5% and 7.5% was associated with lower incident dementia, although they found risk was increased even at lower glycemic targets.

Authors' comment

"In this cohort study of patients with T2D, the findings strengthened evidence of an association of glycemic control with dementia incidence, and revealed that a multidisciplinary primary care diabetes management program was associated with beneficial outcomes for T2D patients against dementia and its major subtypes."

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