Factors such as hypoglycemia, hyperglycemia and glycemic variability have been associated with an increased risk of Alzheimer’s disease. Traditional glycemic measures, such as mean glycated hemoglobin (HbA1c), may fail to identify the complex drivers of this association between diabetes and Alzheimer’s disease.
The duration of HbA1c in the target range is a measure of glycemic control that expresses the stability of HbA1c over time and may help explain the association between glucose levels over time and the incidence of dementia.
Long-term stability of HbA1c within the target range but individualized therefore makes it possible to prevent the risk of Alzheimer’s disease and associated dementias in elderly diabetic patients. Furthermore, this suggests that these patients,
when they have only been able to maintain their HbA1c level within the recommended range for too short periods of time, are at increased risk of Alzheimer’s
and should therefore be monitored further cognitively.
The study cohort is conducted among 374,021 veteran participants aged 65 and over with diabetes and followed from 2004 to 2018. All participants underwent 4 HbA1c tests during follow-up. The analysis reveals that:
- during follow-up, 11% of participants developed Alzheimer’s disease or related dementia;
- greater stability of HbA1c within the range of HbA1c values, over time and over a long period of time is associated with a reduced risk of Alzheimer’s disease;
- when HbA1c levels are outside the recommended range, the higher the duration outside the recommended range, and the longer
the risk of dementia increases, up to 25%;
- this result applies to elderly patients who do not have an antidiabetic prescription.
These results confirm that for older adults with diabetes, maintaining HbA1c stability within target ranges over time is associated with lower risk of Alzheimer’s.
The cognitive implications in terms of glycemic monitoring are thus evident in this group of patients.
Health
