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Impact of type 2 diabetes and glycated hemoglobin levels within the recommended target range on mortality in older adults with cognitive impairment receiving care at a memory clinic: NCGG-STORIES

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posted on 2024-03-12, 18:12 authored by Taiki Sugimoto, Takashi Sakurai, Kazuaki Uchida, Yujiro Kuroda, Haruhiko Tokuda, Takuya Omura, Taiji Noguchi, Ayane Komatsu, Takeshi Nakagawa, Kosuke Fujita, Nanae Matsumoto, Rei Ono, Paul K Crane, Tami Saito

Objective: To determine the impact of type 2 diabetes and glycated hemoglobin (HbA1c) levels within the recommended target range according to the Japan Diabetes Society/Japan Geriatrics Society Joint Committee on mortality in older adults with cognitive impairment.

Research Design and Methods: This retrospective cohort study included 1,528 and 468 patients aged ≥65 years without and with type 2 diabetes, respectively, who were visiting a memory clinic. The 468 patients with type 2 diabetes were divided into three groups (within/above/below the target range) based on their HbA1c levels, cognitive function, ability to perform activities of daily living, and medications associated with a high risk of hypoglycemia. The impact of diabetes and HbA1c levels on mortality was evaluated using Cox proportional hazard models.

Results: Over a median follow-up period of 3.8 years, 353 patients (17.7%) died. Compared with individuals without type 2 diabetes, HbA1c levels above (hazard ratio [HR] = 1.70, 95% confidence interval [CI] = 1.08–2.69) and below (HR = 2.15, 95% CI = 1.33–3.48) the target range were associated with a higher risk of death; however, HbA1c levels within the target range were not (HR = 1.02, 95% CI = 0.77–1.36).

Conclusions: HbA1c levels above and below the target range were associated with a higher risk of mortality, whereas patients with HbA1c levels within the target range did not exhibit a higher risk of mortality than individuals without type 2 diabetes. These results provide empirical support for the current target ranges among older adults with cognitive impairment.

Funding

This work was supported by JSPS KAKENHI (Grant Number 21K17675, 19H03915, 16KT0014) from the Japan Society for the Promotion of Science, grants for young researchers from the Japan Association for Diabetes Education and Care, and the Research Funding for Longevity Sciences [grant numbers 21-45, 22-23] from the National Center for Geriatrics and Gerontology. T.Su received a research fellowship from the Manpei Suzuki Diabetes Foundation and a grant from the Keiko-Yamasaki Memorial Funds. The funders had no role in the study design, methods, data collection, analysis, and preparation of the paper.

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