期刊
DIABETES CARE
卷 42, 期 7, 页码 1248-1254出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc19-0120
关键词
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资金
- National Heart, Lung, and Blood Institute (NHLBI) [HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I]
- National Institutes of Health (NIH) from the NHLBI, National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders [2U01-HL-096812, 2U01-HL-096814, 2U01-HL-096899, 2U01-HL-096902, 2U01-HL-096917]
- NHLBI [R01-HL-70825]
- NIH/National Institute of Diabetes and Digestive and Kidney Diseases [R01-DK-089174]
- NIH/National Institute on Aging [R01-AG-057869]
OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS We conducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017). We defined incident cognitive impairment as incident MCI or incident dementia in persons dementia-free at the index examination; we also examined each outcome separately. Diabetes was defined using self-report, medications, or HbA(1c) >= 6.5%; poor glycemic control in persons with diabetes was defined as HbA(1c) >= 7%. We examined the following biomarkers of hyperglycemia: HbA(1c), fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59% were female, and 21% were black. Diabetes (hazard ratio [HR] 1.14 [95% CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95% CI 1.05, 1.63]), and longer diabetes duration (>= 5 vs. <5 years; HR 1.59 [95% CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA(1c) and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA(1c). HbA(1c) and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.
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