Spending less time in HbA1c target range may increase dementia risk for older adults
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Key takeaways:
- Older adults who spend less time in their designated HbA1c range have higher risks for Alzheimer’s disease and dementias.
- Time below HbA1c range of 60% or higher increased risk for dementia.
Older adults with diabetes who spend less time within their individualized HbA1c target range have a higher risk for developing Alzheimer’s disease and dementias, according to findings published in JAMA Network Open.
In an analysis of Veterans Health Administration and Medicare data, veterans aged 65 years and older with diabetes were assigned an HbA1c target range based on measurements during a 3-year baseline period. During follow-up, adults who spent less than 20% of the time within their HbA1c target range had a 19% higher risk for Alzheimer’s disease and other related dementias than adults who spent 80% or more time in their target HbA1c range.
“Clinicians should work with patients to ensure HbA1c stability and avoid hypoglycemia to reduce Alzheimer’s disease and related dementia risk,” Paul R. Conlin, MD, chief of medical service at the VA Boston Healthcare System and professor of medicine at Harvard Medical School, told Healio. “For some patients, higher HbA1c levels may be appropriate.”
Conlin and colleagues collected data from 374,021 adults aged 65 years and older with diabetes from 2004 to 2018 (mean age, 73.2 years; 87% white). Initial HbA1c was recorded during a 1-year period. A 3-year baseline period was used to establish an HbA1c target range for each adult. Target ranges were determined using each person’s life expectancy, comorbidities and diabetes complications. Adults were followed from the end of the baseline period until an Alzheimer’s disease or related dementia diagnosis, death or the end of the study in 2018.
Of the study group, 25.2% had an HbA1c target of 6% to 7%, 34.4% had a target range of 7% to 8%, 33.4% had an HbA1c target of 7.5% to 8.5%, and the target range was 8% to 9% for 7.4% of adults. During follow-up, 11% of participants developed Alzheimer’s disease or related dementias.
In adjusted analysis, adults who spent less than 20% of time in their HbA1c range during the outcome period had a higher risk for Alzheimer’s disease or related dementias than those who spent 80% or more time in their HbA1c target range (adjusted HR = 1.19; 95% CI, 1.16-1.23). Adults who spent 60% or more of their time below their HbA1c target range also had a higher risk for Alzheimer’s disease or related dementias than those who spent 60% or more of their time in HbA1c range (aHR = 1.23; 95% CI, 1.16-1.27). No difference in risk was observed for adults with a time above HbA1c range of 60% or higher and those with a time in HbA1c range of 60% or higher.
“What surprised us was that risks persisted even when we removed patients with a history of severe hypoglycemia and those using medications associated with hypoglycemia, such as insulin and sulfonylureas,” Conlin said. “Thus, although older adults with diabetes may desire lower glucose levels, these data suggest that maintaining HbA1c levels below clinically relevant target ranges is associated with increased risk of Alzheimer’s disease and related dementias.”
Conlin said prospective studies are needed to see whether improving HbA1c stability can lower the risk for Alzheimer’s disease and related dementias.
For more information:
Paul R. Conlin, MD, can be reached at paul.conlin@va.gov.
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