糖化血红蛋白A1c时间范围和老年糖尿病成年人的痴呆症
Patricia C Underwood1,2, Libin Zhang3, David C Mohr4,5
1William F. Connell School of Nursing, Boston College, Boston, Massachusetts.
JAMA network open
|August 2, 2024
概括
通过HbA1c Time in Range (TIR) 测量稳定的血糖水平与糖尿病老年人患阿尔茨海默病和相关痴呆症 (ADRD) 的风险降低有关. 较低的HbA1c TIR可能表明ADRD的风险更高.
科学领域:
- 老年学是一门学科.
- 神经学 神经学
- 内分泌学 在内分泌学.
背景情况:
- 糖尿病是阿尔茨海默病和相关痴呆症 (ADRD) 患者的常见并发症.
- 血糖变化和极端的葡萄糖水平 (低血糖,高血糖) 与ADRD风险有关.
- 像平均HbA1c这样的传统措施可能无法捕捉与ADRD病变发生相关的动态血糖模式.
研究的目的:
- 调查血红蛋白A1c时间范围 (HbA1c TIR) 与糖尿病老年退伍军人的ADRD发病率之间的联系.
- 确定通过HbA1c TIR测量的血糖稳定性是否是ADRD风险的预测指标.
主要方法:
- 一项使用退伍军人卫生管理局和医疗保险 (2004-2018) 的行政和医疗保健数据的队列研究.
- 包括65岁以上的退伍军人糖尿病和至少4个HbA1c测试在基线期间.
- 计算HbA1c TIR作为个性化目标范围内的天数的百分比;调整后的Cox比例危险回归模型被用于估计与ADRD发病率的关联.
主要成果:
- 该研究包括374,021名患有糖尿病的退伍军人;在长达10年的随访期间,11%的人患有ADRD.
- 较低的HbA1c TIR与发生ADRD的风险增加显著相关 (HR为0-<20%TIR与≥80%TIR:1.19).
- 在HbA1c低于目标范围的较长时间也与ADRD风险增加有关 (HR为≥60%的时间低于范围vs≥60%的TIR:1.23).
结论:
- 增加的血糖稳定性,反映在患者特定范围内更高的HbA1c TIR,与糖尿病老年人ADRD风险降低有关.
- HbA1c TIR 作为一个潜在的有价值的指标,用于识别患有糖尿病的个体,这些人患ADRD的风险更高.
- 这些发现强调了超出平均水平的血糖控制在神经退行性疾病风险的背景下的重要性.
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