Controlling risk factors has helped people with diabetes avoid dementia, according to a new UK study.
In a prospective study of nearly 90,000 participants, people with type 2 diabetes had an 88% higher risk of incident dementia compared to controls without diabetes, reported Thomas van Sloten, MD, PhD, of Maastricht University Medical Center in the Netherlands, at the virtual meeting of the European Association for the Study of Diabetes (EASD).
However, diabetic patients who had five to seven risk factors within the target range recommended by the guidelines – including non-smoker, HbA1c levels, blood pressure, BMI, albuminuria, physical activity and diet – had no increased risk of dementia compared with controls (absolute rate difference per 1,000 person-years 0.20; HR 1.32, 95% CI 0.89-1 , 95).
The risk of incident dementia only appeared to increase when patients checked more boxes for non-target risk factors:
- Four risk factors on target: HR 1.70 (95% CI 1.23-2.33)
- Three risk factors on target: HR 2.33 (95% CI 1.73-3.15)
- Zero to two risk factors on target: HR 2.42 (95% CI 1.67-3.52)
In addition to this, patients who kept control of lifestyle risk factors also saw fewer changes in cognitive processing speed, executive functioning, and brain volume.
The results of the study were also published in Diabetic treatments.
“Dementia is a devastating disease that is feared by many patients, their caregivers and clinicians. However, the effect of current management of type 2 diabetes on the risk of dementia is not fully understood,” said van Sloten. MedPage today. “The current management of type 2 diabetes involves promoting a healthy lifestyle as well as meeting treatment goals such as blood sugar control. “
“This multidomain diabetes management strategy is effective in reducing the risk of cardiovascular disease, but the effect on dementia has been less clear,” he added. “We therefore wanted to study to what extent dementia in people with diabetes can be potentially prevented by targeting multiple risk factors.”
van Sloten noted that “the pathophysiology of dementia associated with type 2 diabetes is likely determined by multiple etiologies, including large vessel disease, microvascular dysfunction and neurodegeneration. Given the multifactorial nature of dementia in diabetes, we hypothesized that interventions targeting multiple risk factors and simultaneous mechanisms may be necessary for optimal preventive effects. “
“The seven risk factors selected in our study (…) were each associated with one or more of these aetiologies,” he added.
The analysis was based on data from the UK Biobank study, a population-based cohort of participants aged 40 to 69, who were recruited from 2006 to 2010, and included 10,663 people with type 2 diabetes. who were then compared to 77,193 witnesses. Diabetes has been defined as self-reported diabetes, use of a hypoglycemic medication, and fasting blood sugar. People with prediabetes were excluded.
After a mean follow-up of 9 years, 1.4% of people with diabetes were diagnosed with incident dementia, while only 0.5% of controls were diagnosed. Brain changes were measured via 3T MRI, specifically assessing white matter hyperintensity volume, total brain parenchyma volume, and lacunar infarcts. Memory was measured with the pair memory test and processing speed was measured with the reaction time test.
Regarding the seven risk factors, the target ranges recommended by the guidelines were: HbA1c less than 7%, blood pressure less than 130/80 mm Hg, BMI of 20 to less than 25, no microalbuminuria or macroalbuminuria, at least 150 minutes / week of moderate to vigorous physical activity, a healthy diet defined as optimal by the American Heart Association score and no smoking.
The researchers noted that they did not view cholesterol levels as a risk factor because the link to cognitive dysfunction and structural abnormalities in the brain “is inconsistent.”
The group saw no interaction with age or gender in relation to the results.
Some limitations of the study were that the cohort was largely made up of middle-aged white individuals and the average follow-up period was only 9 years.
Ultimately, these findings provide “important evidence for physicians to promote current strategies for treating multifactorial risk factors in diabetes and to encourage the adoption of healthy habits in their patients,” said van Sloten. .
van Sloten and his co-authors did not report any disclosures.