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Glycemic control and dementia risk in patients aged above and below 75 years

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Abstract

Background

There is a lack of data about the treatment effect of glycemic control on incident dementia in patients with advanced age.

Methods

In a nationwide Korean cohort of 79,076 diabetic patients 75 years or older and a representative cohort of 74,672 diabetics aged 50 to 74 years, multivariable-adjusted incidence of overt dementia was estimated across yearly-averaged on-treatment fasting blood glucose (FBG) levels.

Results

During 9-year follow-up, overt dementia was noted in 24,710 (31.2%) patients 75 years or older and in 5237 (7.0%) patients aged 50 to 74 years. For dementia risk, J-shaped associations were observed across on-treatment FBG levels (80–99, 100–109, 110–125, 126–139, 140–159, 160–179, and 180–900 mg/dl) in patients 75 years or older (respective incidence: 49.3, 45.7, 45.9, 45.7, 48.5, 51.5, and 57.9 per 1000 person-years) and in those aged 50 to 74 years (respective incidence: 8.9, 8.3, 7.7, 7.6, 8.0, 8.6, and 10.6 per 1000 person-years) with a significant interaction of FBG level and age group (P = 0.001). For all-cause mortality, the J-shaped association curve was left-shifted in patients 75 years or older (respective incidence: 64.9, 59.1, 57.6, 60.4, 64.0, 70.9, and 90.4 per 1000 person-years) relative to that in patients aged 50 to 74 years (respective incidence: 15.7, 13.4, 12.3, 12.2, 13.4, 15.7, and 21.8 per 1000 person-years; P < 0.001 for interaction).

Conclusion

The achieved glycemic level with the lowest risk for dementia and mortality was lower in older patients, and absolute risk increase related to poorly controlled glucose was greater in the elderly compared with younger patients.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the sensitive nature of the data, but requests to access the National Health Information Database may be sent to the data provision review committee of the National Health Insurance Sharing Service (http://nhiss.nhis.or.kr).

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Authors and Affiliations

  1. Department of Medicine, Kangwon National University School of Medicine, Kangwondaehakgil, Chuncheon, Gangwon-Do, 24341, South Korea

    Hae Hyuk Jung

  2. Department of Medicine, Kangwon National University Hospital, 156 Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea

    Hae Hyuk Jung

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Contributions

Conceptualization: JHH. Data curation: JHH. Formal analysis: JHH. Methodology: JHH. Validation: JHH. Visualization: JHH. Writing: JHH.

Corresponding author

Correspondence to Hae Hyuk Jung.

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Conflict of interest

The author declares no conflict of interest to disclosure.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and/or with the Helsinki Declaration of 1964 and later versions. The data used were de-identified before access. Access to the data was approved by the Institutional Review Board of Kangwon National University Hospital (IRB File No. KNHU-A-2021–04-018) on May 12, 2021. The need for informed consent was waived because all data were fully anonymized.

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Jung, H.H. Glycemic control and dementia risk in patients aged above and below 75 years. Diabetol Int 15, 244–252 (2024). https://doi.org/10.1007/s13340-023-00684-4

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  • DOI: https://doi.org/10.1007/s13340-023-00684-4

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