{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:57:29Z","timestamp":1793383049709,"version":"4.5.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Although poorly controlled diabetes is associated with a higher incidence of dementia, few studies have examined the association of diabetes management interventions with dementia incidence.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association of receiving a multidisciplinary diabetes management program (the Risk Assessment and Management Program-Diabetes Mellitus [RAMP-DM]) that enables better glycemic control with subsequent risk of dementia incidence and the association of dementia with glycemic control.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This territory-wide, retrospective, matched cohort study with more than 8 years of follow-up was conducted using electronic health care records from all the patients who used public health care services in Hong Kong from 2011 to 2019. Eligible participants included all patients with type 2 diabetes (T2D) who were managed in primary care settings. Patients who received RAMP-DM were matched in a 1:1 ratio with patients who received usual care only. Data analysis occurred from April 2023 to July 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Diagnosis of T2D, hemoglobin A1C<\/jats:sub> (HbA1C<\/jats:sub>) level, and attendance at a general outpatient clinic or family medicine clinic. Patients received either RAMP-DM or usual care.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Incidence of all-cause dementia and subtypes of dementia were compared between the RAMP-DM and usual care participants using a Cox proportional hazard model with other baseline characteristics, biomarkers, and medication history adjusted. HbA1C<\/jats:sub> levels were measured as a secondary outcome.<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 55\u202f618 matched participants (mean [SD] age, 62.28 [11.90] years; 28\u202f561 female [51.4%]; 27\u202f057 male [48.6%]), including the 27\u202f809 patients in the RAMP-DM group and 27\u202f809 patients in the usual care group, patients had been diagnosed with T2D for a mean (SD) of 5.90 (4.20) years. During a median (IQR) follow-up period of 8.4 (6.8-8.8) years, 1938 patients in the RAMP-DM group (6.97%) and 2728 patients in the usual care group (9.81%) received a diagnosis of dementia. Compared with those receiving usual care, RAMP-DM participants had a lower risk of developing all-cause dementia (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.68-0.77; P<\/jats:italic>\u2009&amp;lt;\u2009.001), Alzheimer disease (aHR, 0.85; 95% CI, 0.76-0.96; P<\/jats:italic>\u2009=\u2009.009), vascular dementia (aHR, 0.61; 95% CI, 0.51-0.73; P<\/jats:italic>\u2009&amp;lt;\u2009.001), and other or unspecified dementia (aHR, 0.71; 95% CI, 0.66-0.77; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Compared with having a mean HbA1C<\/jats:sub> level during the first 3 years after cohort entry between 6.5% and 7.5%, a higher risk of dementia incidence was detected for patients with a 3-year mean HbA1C <\/jats:sub>level greater than 8.5% (aHR, 1.54; 95% CI, 1.31-1.80]), between 7.5% and 8.5% (aHR, 1.33; 95% CI, 1.19-1.48), between 6% and 6.5% (aHR, 1.17; 95% CI, 1.07-1.29), and 6% or less (aHR, 1.39; 95% CI, 1.24-1.57).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of patients with T2D, the findings strengthened evidence of an association of glycemic control with dementia incidence, and revealed that a multidisciplinary primary care diabetes management program was associated with beneficial outcomes for T2D patients against dementia and its major subtypes. A moderate glycemic control target of HbA1C<\/jats:sub> between 6.5% and 7.5% was associated with lower dementia incidence.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.55733","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T16:01:15Z","timestamp":1707753675000},"page":"e2355733","source":"Crossref","is-referenced-by-count":23,"title":["Risk of Dementia Among Patients With Diabetes in a Multidisciplinary, Primary Care Management Program"],"prefix":"10.1001","volume":"7","author":[{"given":"Kailu","family":"Wang","sequence":"first","affiliation":[{"name":"Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health, Tianjin Medical University, Tianjin, 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