Baseline HbA1c and dementia risk at SGLT2i initiation in type 2 diabetes
Authors' conclusion
Baseline HbA1c at SGLT2i initiation predicts dementia risk. Delaying therapy until HbA1c ≥9% may forfeit protection, whereas earlier use may safeguard brain, heart and kidney health.
Study context
- Population
- Adults with T2D initiating SGLT2i between 2005 and 2025, Global Collaborative Network (>150 health systems worldwide)matched cohorts
- Exposure
- Baseline HbA1c 7.0%-8.9% and ≥9.0% vs <7.0% at SGLT2i initiation
- Outcome
- Incident all-cause dementia
- Follow-up
- Median 4.2 years
Methodological detailspropensity-score matched 1:1, 456-day washout, multinational network (>150 health systems)
- Propensity-score matched 1:1
- 456-day washout
- Multinational network (>150 health systems)
Main finding
As reported in the abstract
HR
- HbA1c 7.0%-8.9%
- 1.32
- HbA1c ≥9.0%
- 1.68
- HbA1c 7.0%-8.9% · propensity-score-matched model
- 1.08
- HbA1c ≥9.0% · propensity-score-matched model
- 1.28
Observational data: associations, not effects.
Secondary outcomes
Dementia subtypes; sensitivity analyses
- Associations strongest for vascular dementia and consistent across sensitivity analyses and cause-specific competing-risk Cox models
Original publication
Baseline HbA1c and dementia risk at SGLT2i initiation in type 2 diabetes. Diabetes Obes Metab. Published 20 October 2025. doi:10.
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