PDF(Pubmed)
Abstract：
UNASSIGNED: Individuals with diabetes commonly experience Alzheimer disease and related dementias (ADRD). Factors such as hypoglycemia, hyperglycemia, and glycemic variability have been associated with increased risk of ADRD. Traditional glycemic measures, such as mean glycated hemoglobin A1c (HbA1c), may not identify the dynamic and complex pathophysiologic factors in the association between diabetes and ADRD. The HbA1c time in range (TIR) is a previously developed measure of glycemic control that expresses HbA1c stability over time within specific ranges. This measure may inform the current understanding of the association between glucose levels over time and ADRD incidence.
UNASSIGNED: To examine the association between HbA1c TIR and incidence of ADRD in older veterans with diabetes.
UNASSIGNED: The study sample for this cohort study was obtained from administrative and health care utilization data from the Veterans Health Administration and Medicare from January 1, 2004, to December 31, 2018. Veterans 65 years or older with diabetes were assessed. Participants were required to have at least 4 HbA1c tests during the 3-year baseline period, which could start between January 1, 2005, and December 31, 2014. Data analysis was conducted between July and December 2023.
UNASSIGNED: Hemoglobin A1c TIR was calculated as the percentage of days during baseline in which HbA1c was in individualized target ranges based on clinical characteristics and life expectancy, with higher HbA1c TIR viewed as more favorable. The association between HbA1c TIR and ADRD incidence was estimated. Additional models considered ADRD incidence in participants who were above or below HbA1c target ranges most of the time.
UNASSIGNED: The study included 374 021 veterans with diabetes (mean [SD] age, 73.2 [5.8] years; 369 059 [99%] male). During follow-up of up to 10 years, 41 424 (11%) developed ADRD. Adjusted Cox proportional hazards regression models showed that lower HbA1c TIR was associated with increased risk of incident ADRD (HbA1c TIR of 0 to <20% compared with ≥80%: hazard ratio, 1.19; 95% CI, 1.16-1.23). Furthermore, the direction of out-of-range HbA1c levels was associated with incident ADRD. Having greater time below range (≥60%, compared with ≥60% TIR) was associated with significantly increased risk (hazard ratio, 1.23; 95% CI, 1.19-1.27). Findings remained significant after excluding individuals with baseline use of medications associated with hypoglycemia risk (ie, insulin and sulfonylureas) or with hypoglycemia events.
UNASSIGNED: In this study of older adults with diabetes, increased HbA1c stability within patient-specific target ranges was associated with a lower risk of ADRD. Lower HbA1c TIR may identify patients at increased risk of ADRD.
UNASSIGNED: To examine the association between HbA1c TIR and incidence of ADRD in older veterans with diabetes.
UNASSIGNED: The study sample for this cohort study was obtained from administrative and health care utilization data from the Veterans Health Administration and Medicare from January 1, 2004, to December 31, 2018. Veterans 65 years or older with diabetes were assessed. Participants were required to have at least 4 HbA1c tests during the 3-year baseline period, which could start between January 1, 2005, and December 31, 2014. Data analysis was conducted between July and December 2023.
UNASSIGNED: Hemoglobin A1c TIR was calculated as the percentage of days during baseline in which HbA1c was in individualized target ranges based on clinical characteristics and life expectancy, with higher HbA1c TIR viewed as more favorable. The association between HbA1c TIR and ADRD incidence was estimated. Additional models considered ADRD incidence in participants who were above or below HbA1c target ranges most of the time.
UNASSIGNED: The study included 374 021 veterans with diabetes (mean [SD] age, 73.2 [5.8] years; 369 059 [99%] male). During follow-up of up to 10 years, 41 424 (11%) developed ADRD. Adjusted Cox proportional hazards regression models showed that lower HbA1c TIR was associated with increased risk of incident ADRD (HbA1c TIR of 0 to <20% compared with ≥80%: hazard ratio, 1.19; 95% CI, 1.16-1.23). Furthermore, the direction of out-of-range HbA1c levels was associated with incident ADRD. Having greater time below range (≥60%, compared with ≥60% TIR) was associated with significantly increased risk (hazard ratio, 1.23; 95% CI, 1.19-1.27). Findings remained significant after excluding individuals with baseline use of medications associated with hypoglycemia risk (ie, insulin and sulfonylureas) or with hypoglycemia events.
UNASSIGNED: In this study of older adults with diabetes, increased HbA1c stability within patient-specific target ranges was associated with a lower risk of ADRD. Lower HbA1c TIR may identify patients at increased risk of ADRD.
摘要：
■患有糖尿病的个体通常经历阿尔茨海默病和相关痴呆(ADRD)。因素如低血糖，高血糖症,血糖变异性与ADRD风险增加相关。传统的血糖测量，如平均糖化血红蛋白A1c（HbA1c），可能无法确定糖尿病和ADRD之间的动态和复杂的病理生理因素。HbA1c时间范围(TIR)是先前开发的血糖控制量度,其在特定范围内表达HbA1c随时间的稳定性。该测量可以告知当前对随时间推移的葡萄糖水平与ADRD发生率之间的关联的理解。
■研究HbA1cTIR与老年糖尿病退伍军人ADRD发生率之间的关系。
本队列研究的研究样本来自2004年1月1日至2018年12月31日退伍军人健康管理局和医疗保险的行政和医疗保健利用数据。对65岁或以上的糖尿病退伍军人进行了评估。参与者被要求在3年的基线期间至少进行4次HbA1c测试。可能在2005年1月1日至2014年12月31日之间开始。数据分析于2023年7月至12月进行。
■根据临床特征和预期寿命，将血红蛋白A1cTIR计算为基线期间HbA1c处于个体化目标范围的天数百分比。HbA1c越高，TIR越有利。评估了HbA1cTIR与ADRD发生率之间的关联。其他模型在大多数时间高于或低于HbA1c目标范围的参与者中考虑ADRD发生率。
■该研究包括374021名患有糖尿病的退伍军人（平均[SD]年龄，73.2[5.8]岁；369059[99%]男性）。在长达10年的随访中，41424（11%）发展了ADRD。调整后的Cox比例风险回归模型显示，较低的HbA1cTIR与事件ADRD的风险增加相关（HbA1cTIR为0至<20％，与≥80％相比：危险比，1.19；95%CI，1.16-1.23）。此外，HbA1c水平超出范围的方向与ADRD相关.低于范围的时间更长(≥60%,与≥60%TIR相比)与风险显著增加(风险比，1.23；95%CI，1.19-1.27）。在排除基线使用与低血糖风险相关的药物的个体后，发现仍然显着（即，胰岛素和磺脲类药物）或伴有低血糖事件。
■在这项对患有糖尿病的老年人的研究中，患者特异性目标范围内的HbA1c稳定性增加与ADRD风险降低相关.较低的HbA1cTIR可以识别ADRD风险增加的患者。
■研究HbA1cTIR与老年糖尿病退伍军人ADRD发生率之间的关系。
本队列研究的研究样本来自2004年1月1日至2018年12月31日退伍军人健康管理局和医疗保险的行政和医疗保健利用数据。对65岁或以上的糖尿病退伍军人进行了评估。参与者被要求在3年的基线期间至少进行4次HbA1c测试。可能在2005年1月1日至2014年12月31日之间开始。数据分析于2023年7月至12月进行。
■根据临床特征和预期寿命，将血红蛋白A1cTIR计算为基线期间HbA1c处于个体化目标范围的天数百分比。HbA1c越高，TIR越有利。评估了HbA1cTIR与ADRD发生率之间的关联。其他模型在大多数时间高于或低于HbA1c目标范围的参与者中考虑ADRD发生率。
■该研究包括374021名患有糖尿病的退伍军人（平均[SD]年龄，73.2[5.8]岁；369059[99%]男性）。在长达10年的随访中，41424（11%）发展了ADRD。调整后的Cox比例风险回归模型显示，较低的HbA1cTIR与事件ADRD的风险增加相关（HbA1cTIR为0至<20％，与≥80％相比：危险比，1.19；95%CI，1.16-1.23）。此外，HbA1c水平超出范围的方向与ADRD相关.低于范围的时间更长(≥60%,与≥60%TIR相比)与风险显著增加(风险比，1.23；95%CI，1.19-1.27）。在排除基线使用与低血糖风险相关的药物的个体后，发现仍然显着（即，胰岛素和磺脲类药物）或伴有低血糖事件。
■在这项对患有糖尿病的老年人的研究中，患者特异性目标范围内的HbA1c稳定性增加与ADRD风险降低相关.较低的HbA1cTIR可以识别ADRD风险增加的患者。
