In a recent cohort study published in JAMA network open, Chinese researchers investigated the effect of a multidisciplinary diabetes management program on dementia risk in patients with type 2 diabetes (T2D). They found that glycemic control may be associated with the incidence of dementia and that diabetes management programs may be beneficial for T2DM patients against dementia and its subtypes.
Study: Dementia risk in patients with diabetes in a multidisciplinary primary care management program. Image credit: Africa Studio / Shutterstock
background
Dementia is a significant global health burden, especially for older adults, and the incidence is increasing, particularly among people with T2D. T2D is associated with a 50% higher likelihood of all-cause dementia, and the association with Alzheimer’s disease (AD) and other dementias includes a variety of factors, including vascular damage, amyloid-beta accumulation, and neuroinflammation. Includes pathological features. Elevated hemoglobin A1C (HbA1C) levels in T2D patients are associated with increased dementia risk, but the effectiveness of glycemic control interventions in reducing the incidence of dementia remains unclear. Multidisciplinary diabetes management programs have shown good results in terms of mortality and diabetic complications. However, research on associations with dementia outcomes, particularly regarding long-term follow-up and individualized glycemic control targets, is limited.
In Hong Kong, more than 90% of patients with type 2 diabetes have been managed within the public healthcare system using the Multidisciplinary Risk Assessment and Management Program-Diabetes (RAMP-DM) program since 2009. RAMP-DM demonstrated significant improvement in glycemic control. Reductions in mortality, macrovascular events, and microvascular events over 9 years of follow-up. This study investigates the association between RAMP-DM services, glycemic control, and risk of developing all-cause dementia, providing valuable insights into dementia prevention in patients with T2D.
About research
The current retrospective cohort study utilized electronic medical records from Hong Kong’s public health system. Adult patients diagnosed with T2D in 2011 (excluding patients with type 1 diabetes, gestational diabetes, or pre-existing dementia) were identified. Patients participating in RAMP-DM services and usual care constituted the treatment group, and patients not participating in RAMP-DM constituted the control group. Follow-up (median 8.4 years) continued until occurrence of an outcome event, death, or study end in December 2019. Patients who attended RAMP-DM services between 2012 and 2019 were excluded due to insufficient follow-up for dementia outcomes.
A total of 55,618 patients were included (mean age 68.28 years, 51.4% female), with 27,809 patients in the RAMP-DM group (median age 69 years) and usual care group (median age 70 years). was.
The primary outcome was the incidence of dementia, identified by ICD-10 or ICPC-2 code and prescription of dementia drugs. Causes of dementia unrelated to alcohol, drugs, or infectious agents were considered. Diagnosis followed clinical evaluation with reference to DSM-IV and DSM-5 criteria. Secondary outcomes included AD, vascular dementia (VD), and other types of dementia. The primary analysis focused on RAMP-DM use and investigated the relationship between early HbA1C levels and dementia incidence after joining RAMP-DM. Several covariates were extracted at baseline. Participants with her T2D who received RAMP-DM services were matched to participants who received usual care only using propensity scores. Statistical analyzes included comparison of baseline characteristics, cumulative incidence estimates, use of crude absolute risk reduction (ARR), relative risk reduction (RRR), Kaplan-Meier curves, and multivariate Cox proportional hazards modeling.
Results and discussion
Approximately 6.97% of the RAMP-DM group and 9.81% of the usual care group were diagnosed with dementia. The incidence of dementia per 1000 person-years was lower with RAMP-DM (9.31) than with usual care (14.02). RAMP-DM was shown to significantly reduce the risk of all-cause dementia, AD, VD, and other forms of dementia. Lower HbA1C levels were found in the RAMP-DM group, with RAMP-DM patients having a 28% lower risk of all-cause dementia, a 39% lower risk of VD, a 15% lower risk of AD, and a 29% lower risk of AD. was shown to be low. Other dementia care compared to usual care.
Sensitivity analyzes consistently showed similar results. Subgroup analysis demonstrated RAMP-DM risk reduction across different subgroups, with more pronounced effects in patients with HbA1C ≤7.5% and hypertensive patients. No significant differences were observed based on gender, public assistance, senior housing residence, or CCI score.
This analysis revealed an association between HbA1C levels and dementia risk during follow-up. Compared with the reference group (HbA1C = 6.5-7.5%), patients with levels between 7.5%-8.5% and above 8.5% were at higher risk. Lower HbA1C levels (<6% and 6% to 6.5%) were also associated with increased dementia risk.
This study is limited by the observational design, potential selection bias, unmeasured baseline characteristics that influence dementia incidence, and information bias.
conclusion
In conclusion, this study suggests that a primary care-based multidisciplinary diabetes management program is associated with a reduced risk of all-cause dementia in patients with T2D, highlighting the importance of glycemic control. Prospective studies and trials are needed to confirm efficacy and investigate biological mechanisms.
