The risk for Alzheimer disease was lower in patients with type 2 diabetes than in control subjects (hazard ratio 0.94 [95% CI 0.90, 0.99]) but might result in patients with type 2 diabetes dying earlier than control subjects, which was observed by Celis-Morales et al. (1) in a real-world prospective cohort with a large sample of individuals with type 2 diabetes and 7-year follow-up. We recommend that authors incorporate the death event as a competing risk in the Cox regression, which might clarify whether or to what extent type 2 diabetes contributes to the incident Alzheimer disease.
In addition, the authors also observed a dose–response association between circulating concentration of HbA1c and risk of Alzheimer disease in patients with type 2 diabetes (hazard ratio 1.004 [95% CI 1.001, 1.008]). Considering that more than half (57.8%, 218,702 of 378,299) of patients with type 2 diabetes reached the glycemic targets (HbA1c <7% [53 mmol/mol]) recommended by the American Diabetes Association for nonpregnant adults (2), it is of high importance that we compare the risk of incident Alzheimer disease in adequately controlled patients of type 2 diabetes with that for healthy control subjects. The current opinion indicates that comparing the risk of incident dementia subtypes in patients with type 2 diabetes stratified by glycemic control would provide further evidence on the benefits of glycemic control.
See accompanying article, p. e107.
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Duality of Interest. No potential conflicts of interest relevant to this article were reported.
