Individuals with Type 2 diabetes are at a higher risk of developing dementia. However, the optimal glycemic control levels to mitigate this risk was unclear until a recent study was published in JAMA Neurology. The study, conducted over almost two decades, aimed to identify the levels of glycemic control associated with the lowest risk of dementia in people with Type 2 diabetes
Researchers analyzed the association between cumulative exposure to various ranges of glycated hemoglobin concentrations and dementia risk across different sexes, racial, and ethnic groups. They also examined the link between therapeutic glycemic targets and dementia risk. The study found that individuals with Type 2 diabetes and a history of high glycemic levels may have an increased risk of developing dementia.
The study, which included over 250,000 members of the Kaiser Permanente Northern California integrated health care system aged 50 or older with type 2 diabetes, found that individuals with more than 50% of HbA1c measurements at 9% to less than 10% or 10% or more had a greater risk of dementia compared to those who had 50% or less of measurements in those categories. By contrast, participants with over 50% of HbA1c concentrations less than 6%, 6% to less than 7%, or 7% to less than 8% had a lower risk of dementia.
These findings have important implications for healthcare professionals who care for older people with type 2 diabetes. The results support current guidelines that recommend relaxed glycemic targets for this population, as strict glycemic control may not be necessary and could even be detrimental to cognitive health.
It is important to note that this study had some limitations, including the use of administrative data to identify dementia cases, which may not have captured all cases, and the lack of information on diabetes duration, treatment, and complications. However, the large sample size and long follow-up period provide strong evidence for the association between HbA1c levels and dementia risk.
It is crucial to consider the potential cognitive effects of glycemic control when setting individualized treatment goals for older people with type 2 diabetes. While glycemic control is still important to prevent complications such as retinopathy, neuropathy, and cardiovascular disease, it is reassuring to know that relaxed glycemic targets may also benefit this population’s cognitive health.
This study highlights the importance of glycemic control in reducing the risk of dementia in people with type 2 diabetes. The findings suggest that relaxed glycemic targets may be optimal for older adults with diabetes, and healthcare professionals should consider these findings when setting individualized treatment goals for their patients.