Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes
Main finding · Incident ADRDResult — go to the resultHazard ratio 1.19 95% CI 1.16–1.23Authors' conclusion
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.
Study context
- Population
- Veterans aged ≥65 years with diabetes and ≥4 hemoglobin A1c (HbA1c) tests during a 3-year baseline period (VHA and Medicare data, 2004–2018); mean age 73.2 years, 99% male
- Participants
- 374,021 veterans
- Exposure
- HbA1c time in range (TIR) categories
- Outcome
- Incident ADRD by HbA1c TIR (% of baseline days with HbA1c in individualized target ranges)
- Follow-up
- Up to 10 years
Methodological detailsVeterans Health Administration and Medicare administrative data, adjusted Cox proportional hazards regression
- Veterans Health Administration and Medicare administrative data
- Adjusted Cox proportional hazards regression
Main finding
Incident ADRD
Hazard ratio
1.19
95% CI 1.16–1.23
HbA1c TIR 0 to <20%vs HbA1c TIR ≥80%
HR 1.19 (95% CI 1.16–1.23)
As reported in the abstract
- Developed and related dementias (ADRD) during follow-up (all participants)
- 41 424 (11%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Incident ADRD with greater time below range (≥60%)vs ≥60% TIR | 1.23 (1.19–1.27) | |
| 0.512Hazard ratio (log scale) |
Sensitivity analyses excluding baseline insulin or SU use, or hypoglycemia events
- Findings remained significant
Original publication
Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes. JAMA Netw Open. Published 1 August 2024. doi:10.
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