Risk of Dementia Among Patients With Diabetes in a Multidisciplinary, Primary Care Management Program
Main finding · All-cause dementiaResult — go to the resultAdjusted hazard ratio 0.72 95% CI 0.68–0.77Authors' conclusion
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. A moderate glycemic control target of HbA1C between 6.5% and 7.5% was associated with lower dementia incidence.
Study context
- Population
- Patients with T2D managed in primary care, public health care services in Hong Kong 2011–2019; mean age 62.28 years, 51.4% female; mean T2D duration 5.90 yearsmatched cohort
- Participants
- 55,618 patients
- Exposure
- RAMP-DM vs usual care
- RAMP-DMn = 27,809
- Usual caren = 27,809reference
- Outcome
- Incidence of all-cause dementia and subtypes of dementia
- Follow-up
- Median 8.4 (IQR 6.8-8.8) years
Methodological detailsterritory-wide, matched 1:1
- Territory-wide
- Matched 1:1
Main finding
All-cause dementia · median follow-up 8.4 years
Adjusted hazard ratio
0.72
95% CI 0.68–0.77
P < 0.001
Events by group
RAMP-DMvs Usual care
aHR 0.72 (95% CI 0.68–0.77); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | P value | |
|---|---|---|---|
| Dementia subtypesRAMP-DMvs Usual care | aHR (Alzheimer disease) 0.85 (95% CI 0.76–0.96) | P = 0.009 | |
| Dementia subtypesRAMP-DMvs Usual care | aHR (vascular dementia) 0.61 (95% CI 0.51–0.73) | P < 0.001 | |
| Dementia subtypesRAMP-DMvs Usual care | aHR (other or unspecified dementia) 0.71 (95% CI 0.66–0.77) | P < 0.001 | |
| Dementia incidence by 3-year mean HbA1c (reference 6.5%–7.5%) · first 3 years after cohort entryHbA1c >8.5%vs HbA1c 6.5%–7.5% | aHR 1.54 (95% CI 1.31–1.80) | ||
| Dementia incidence by 3-year mean HbA1c (reference 6.5%–7.5%) · first 3 years after cohort entryHbA1c 7.5%–8.5%vs HbA1c 6.5%–7.5% | aHR 1.33 (95% CI 1.19–1.48) | ||
| Dementia incidence by 3-year mean HbA1c (reference 6.5%–7.5%) · first 3 years after cohort entryHbA1c 6%–6.5%vs HbA1c 6.5%–7.5% | aHR 1.17 (95% CI 1.07–1.29) | ||
| Dementia incidence by 3-year mean HbA1c (reference 6.5%–7.5%) · first 3 years after cohort entryHbA1c ≤6%vs HbA1c 6.5%–7.5% | aHR 1.39 (95% CI 1.24–1.57) | ||
| 0.512Ratio (log scale) |
Original publication
Risk of Dementia Among Patients With Diabetes in a Multidisciplinary, Primary Care Management Program. JAMA Netw Open. Published 5 February 2024. doi:10.
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