{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:51:17Z","timestamp":1791809477374,"version":"4.3.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) is a major risk factor for dementia, yet the prognostic value of early dynamic glycemic changes following glucose-lowering therapy remains underinvestigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether early glycated hemoglobin (HbA1c) trajectories after initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) predict long-term dementia and mortality risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective new-user cohort study utilized electronic health records from the TriNetX Global Network. Adults with T2DM initiating their first SGLT2i were included. To mitigate immortal-time bias, a 1-year landmark design was applied. Patients were stratified by baseline HbA1c and classified into improved, stable, or worsened trajectories based on values 91\u2013455 days post-initiation. Propensity-score matching was performed within strata. The primary outcome was all-cause dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 172,050 matched patients, modest HbA1c worsening in those with Good baseline control (&lt;7.0%) did not increase dementia risk (HR 0.93; 95% CI, 0.75\u20131.15). However, in patients with Fair baseline control (7.0\u20138.9%), worsening to Poor control significantly increased dementia (HR 1.39; 95% CI, 1.11\u20131.74) and mortality risks. Conversely, among those with Poor baseline control (\u22659.0%), trajectory improvement conferred substantial neuroprotection, reducing the risk of dementia (HR 0.64; 95% CI, 0.51\u20130.79) and mortality (HR 0.71; 95% CI, 0.60\u20130.84). These findings provide clinically actionable evidence linking glycemic dynamics to neurodegenerative risk, particularly Alzheimer's disease and related dementias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dynamic HbA1c trajectories following SGLT2i initiation independently predict dementia risk. Integrating trajectory-based assessments into routine care provides an actionable, scalable biomarker to guide timely treatment intensification and mitigate diabetes-related neurocognitive decline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261462927","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:07:12Z","timestamp":1783433232000},"page":"1855-1863","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["HbA1c trajectories after SGLT2 inhibitor initiation and the risk of dementia"],"prefix":"10.1177","volume":"112","author":[{"given":"Jiaqiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Henan Provincial People's Hospital"},{"name":"Institute of Electrophysiology, Henan Academy of Innovations in Medical Science, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongyuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"},{"name":"Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitian","family":"Yang","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"},{"name":"Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"},{"name":"Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangfang","family":"Li","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengrong","family":"Miao","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Fu Jen Catholic University"},{"name":"Fu Jen Catholic University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5637-558X","authenticated-orcid":false,"given":"Szu-Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Fu Jen Catholic University"},{"name":"Fu Jen Catholic University"},{"name":"Asia University"},{"name":"Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan"},{"name":"Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan"},{"name":"Asia University"},{"name":"Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan"},{"name":"Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyang","family":"Sun","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Hospital"},{"name":"Institute of Electrophysiology, Henan Academy of Innovations in Medical Science, Zhengzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"4. 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