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Age of diabetes diagnosis and lifetime risk of dementia: The Atherosclerosis Risk in Communities (ARIC) Study

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posted on 2024-06-27, 17:22 authored by Jiaqi Hu, James R. Pike, Pamela L. Lutsey, A. Richey Sharrett, Lynne E. Wagenknecht, Timothy M. Hughes, Jesse C. Seegmiller, Rebecca F. Gottesman, Thomas H. Mosley, Elizabeth Selvin, Michael Fang, Josef Coresh

Objective The impact of age of diabetes diagnosis on dementia risk across the life course is poorly characterized. We estimated the lifetime risk of dementia by age of diabetes diagnosis. Research design and methods We included 13,087 participants from the Atherosclerosis Risk in Communities Study who were free from dementia at age 60 years. We categorized participants as having middle-age onset diabetes (diagnosis <60 years), older onset diabetes (diagnosis ≥ 60 years), or no diabetes. Incident dementia was ascertained via adjudication and active surveillance. We used the cumulative incidence function estimator to characterize the lifetime risk of dementia by age of diabetes diagnosis while accounting for the competing risk of mortality. We used restricted mean survival time to calculate years lived without and with dementia. Results Among 13,087 participants, there were 2,982 dementia cases and 4,662 deaths without dementia during a median follow-up of 24.1 (p25 17.4, p75 28.3) years. Persons with middle-age onset diabetes had a significantly higher lifetime risk of dementia than those with older onset diabetes (36.0% versus 31.0%). Compared to those with no diabetes, participants with middle-age onset diabetes also had a higher cumulative incidence of dementia by age 80 years (16.1% versus 9.4%), but a lower lifetime risk (36.0% versus 45.6%) due to shorter survival. Persons with middle-age onset diabetes developed dementia 4 and 1 years earlier than those without diabetes and those with older onset diabetes. Conclusions Preventing or delaying diabetes may be an important approach for reducing dementia risk throughout the life course.

Funding

The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005). The ARIC Neurocognitive Study is supported by U01HL096812, U01HL096814, U01HL096899, U01HL096902, and U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD). The authors thank the staff and participants of the ARIC study for their important contributions. PLL was supported by NIH/NHLBI grant K24 HL159246. RFG was supported by the National Institute of Neurological Disorders and Stroke Intramural Research Program. ES was supported by NIH/NHLBI grants K24 HL152440 and R01 HL158022, NIH/NIDDK grants R01 DK089174 and R01 DK128837, and NIH/NIA grant RF1 AG074044. MF was supported by NIH/NHLBI grant K01 DK138273-01.

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