Long-term average HbA1c greater than 9% in adults with T2DM associated with increased risk of dementia

Clinical Question

What is the association between long-term glycemic control and developing dementia in adults with type 2 diabetes mellitus?

Bottom line

In this large population-based cohort, older adults with T2DM whose cumulative glycemic control was greater 9% were at increased risk of developing dementia. (LOE = 2b)

Overuse alert:This POEM aligns with the Canadian Geriatric Society’s Choosing Wisely Canada recommendation: Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults age 65 and older; moderate control is generally better.

Study design: Cohort (retrospective)

Funding: Government

Setting: Population-based


Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI

Discuss this POEM



Glycemic control in elderly Type 2 DM

Important new data. a lot of Type 2 mature diabetics don't think tight control is necessary.


Impact assessment



HbA1c and Dementia

Is the advice then to target HbA1c to 7.5 to 9?

Roland Michael Grad

A sweet spot?

Looks like an a1c of 7.5 to 8.5% is most reasonable, with progressively less concern as we age.