Diabetes management program in primary care reduces risk for dementia

Key takeaways:

• An intervention reduced the risk for all-cause dementia and vascular dementia by 28% and 39%, respectively.
• Evidence suggests that glycemic control plays a role in the risk for dementia.

A program geared toward diabetes management in the primary care setting helped to reduce patients’ risk for dementia — including Alzheimer’s disease — according to researchers.

Kailu Wang, PhD, a research assistant professor from the Chinese University of Hong Kong, and colleagues wrote that although a higher HbA1c level is associated with greater risk for dementia in patients with type 2 diabetes, “the effectiveness of glycemic control interventions to reduce dementia incidence remains uncertain.”

“To facilitate better management of [type 2 diabetes], management programs involving multidisciplinary teams that consist of primary care clinicians, specialists, nurses and allied health professionals have been implemented in many countries,” they wrote in JAMA Network Open.

In the Risk Assessment and Management Program-Diabetes Mellitus (RAMP-DM) intervention, patients with type 2 diabetes received comprehensive assessments on lifestyle behaviors and drug adherence, screening for diabetes complications and education on diabetes management. Patients were referred to primary care physicians or specialists based on their risk assessment during intake.

In Wang and colleagues’ retrospective cohort study, patients who were enrolled in RAMP-DM (n = 27,809) were matched in a 1:1 ratio with patients who received usual care (n = 27,809).

Over a median 8.4 years of follow-up, 6.9% of patients enrolled in RAMP-DM and 9.8% of patients assigned to usual care had a diagnosis of dementia.

The researchers found that patients in RAMP-DM vs. those who received usual care had a:

• 28% lower risk for all-cause dementia (adjusted HR = 0.72; 95% CI, 0.68-0.77);
• 15% lower risk for Alzheimer’s disease (aHR = 0.85; 95% CI, 0.76-0.96);
• 39% lower risk for vascular dementia (aHR = 0.61; 95% CI, 0.51-0.73); and a
• 29% lower risk for other or unspecified dementia (aHR = 0.71; 95% CI, 0.66-0.77).

Meanwhile, compared with having a mean HbA1c level between 6.5% to 7.5% in the first 3 years after cohort entry, a higher risk for dementia incidence was found among patients who had a 3-year mean HbA1c level that was:

• greater than 8.5% (aHR = 1.54; 95% CI, 1.31-1.8);
• between 7.5% to 8.5% (aHR = 1.33; 95% CI, 1.19-1.48);
• between 6% and 6.5% (aHR = 1.17; 95% CI, 1.07-1.29); and
• 6% or less (aHR = 1.39; 95% CI, 1.24-1.57).

When viewed alongside previous research, these findings suggest that “that poor glycemic

control may be a factor underlying the association with dementia incidence,” the researchers said.

Wang and colleagues explained that the neurological benefits from RAMP-DM could come from its risk stratification process and multidisciplinary coordination.

“Risk stratification in RAMP-DM can prioritize patients’ needs for diabetes management based on their risk level and may potentially enable more individualized management of glycemic levels that may reduce the risk of hypoglycemic events,” they wrote.

The researchers concluded future research “could make use of prospective cohorts or [randomized controlled trials] to verify the effectiveness of similar diabetic management interventions on dementia risks and investigate the biological mechanism of such effects.”

“The cost-effectiveness of such a program for reducing the risk of dementia incidence also requires further evaluation,” they wrote.