Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Glycemic Control, Dementia Risk in Type 1 Diabetes

Diabetes Care; ePub 2018 Sep 4; Lacy, Gilsanz, et al

Among older patients with type 1 diabetes (T1D), those with majority exposure to HbA1c 8–8.9% and ≥9% had increased dementia risk, while those with majority exposure to HbA1c 6–6.9% and 7–7.9% had reduced risk. This according to a recent study that investigated the association of long-term glycemic control with dementia in older individuals with T1D. Researchers followed 3,433 members of a health care system with T1D, aged ≥50 years, from 1996 to 2015. They found:

  • Over a mean follow-up of 6.3 years, 155 individuals (4.5%) were diagnosed with dementia.
  • Patients with ≥50% of HbA1c measurements at 8–8.9% (64–74 mmol/mol) and ≥9% (≥75 mmol/mol) had 65% and 79% higher risk of dementia, respectively, compared with those with <50% of measurements exposed (HbA1c 8–8.9% adjusted hazard ratio [aHR] 1.65 and HbA1c ≥9% aHR 1.79).
  • By contrast, patients with ≥50% of HbA1c measurements at 6–6.9% (42–52 mmol/mol) and 7–7.9% (53–63 mmol/mol) had a 45% lower risk of dementia (HbA1c 6–6.9% aHR 0.55 and HbA1c 7–7.9% aHR 0.55).


Lacy ME, Gilsanz P, Karter AJ, Quesenberry CP, Pletcher MJ, Whitmer RA. Long-term glycemic control and dementia risk in type 1 diabetes. [Published online ahead of print September 4, 2018]. Diabetes Care. doi:10.2337/dc18-0073.