Well-managed blood sugar through multidisciplinary care can stave off dementia in T2D patients

A multidisciplinary intervention program for type 2 diabetes (T2D) in the primary care setting subsequently reduces the incidence of dementia, as reported in a study.

Analysis of the electronic health records (EHRs) collected from the public health care system in Hong Kong showed that over a median follow-up of 8.4 years, T2D patients who underwent a multidisciplinary diabetes management program (the Risk Assessment and Management Program-Diabetes Mellitus [RAMP-DM]) had a 28-percent lower risk of all-cause dementia compared with their counterparts who received usual care (6.97 percent vs 9.81 percent; adjusted hazard ratio [aHR], 0.72, 95 percent confidence interval [CI], 0.68–0.77; p<0.001). [JAMA Netw Open 2024;7:e2355733]

The same was true for other subtypes of dementia such as Alzheimer’s disease (aHR, 0.85, 95 percent CI, 0.76–0.96; p=0.009), vascular dementia (aHR, 0.61, 95 percent CI, 0.51–0.73; p<0.001), and other or unspecified dementia (aHR, 0.71, 95 percent CI, 0.66–0.77; p<0.001).

According to the investigators, RAMP-DM may confer neurologic benefits by, first, prioritizing patient’s diabetes management needs based on their risk level and, second, coordinating care across different medical specialists. [Diabetes Care 2022;45:2871-2882; Diabetes Care 2018;41:49-59]

Such level of care, they said, can facilitate precise management of blood sugar levels, potentially reducing the frequency and severity of hypoglycaemic episodes, which are a risk factor for dementia. [JAMA 2009;301:1565-1572; Diabetes Care 2021;44:1556-1563; Age Ageing 2019;48:838-844]

In the present study, having a mean HbA1C level of >8.5 percent during the first 3 years was associated with a 54-percent increase in dementia risk compared with a mean HbA1C level of 6.5 percent to 7.5 percent (aHR, 1.54, 95 percent CI, 1.31–1.80). This risk increase was greater than that associated with a 3-year mean HbA1C levels of between 7.5 percent and 8.5 percent (aHR, 1.33, 95 percent CI, 1.19–1.48), between 6 percent and 6.5 percent (aHR, 1.17, 95 percent CI, 1.07–1.29), and ≤6 percent (aHR, 1.39, 95 percent CI, 1.24–1.57).

Under the multidisciplinary care framework, nurses and other healthcare professionals can regularly check in with the patients to keep their glucose levels within the target range, the investigators pointed out.

“In addition, RAMP-DM may enable modifications on several factors associated with T2D risk, such as obesity and physical inactivity, which are also associated with increased risk of dementia independent from T2D,” they continued. [Lancet Neurol 2020;19:559-560]

The study population comprised 55,618 matched T2D patients (mean age 62.28 years, 51.40 percent women, mean disease duration 5.90 years), of whom 27,809 were in the RAMP-DM group and 27,809 were in the usual care group.