Xiao Yanhua, Hong Xuezhi, Neelagar Ranjana, Mo Hanyou
Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany.
Sci Rep. 2025 Feb 11;15(1):5011. doi: 10.1038/s41598-025-89374-6.
Cognitive impairment (CI) is a common complication in patients with type 2 diabetes mellitus (T2DM), but its relationship with long-term glycemic control remains unclear. This study aimed to investigate the associations between mean hemoglobin A1c (HbA1c) levels, HbA1c control status, HbA1c fluctuations, and CI in Chinese adults aged 45 years and older with T2DM using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 797 participants with HbA1c measurements from 2011 to 2015 and cognitive function assessments in 2018 were included. Logistic regression models and restricted cubic spline (RCS) analysis were applied, adjusting for potential confounders. Higher mean HbA1c levels (≥ 9%) were significantly associated with an increased risk of CI, particularly in global cognition and episodic memory (OR 4.03 (1.45-11.20) for global cognition; OR 2.92 (1.02-8.38) for episodic memory). RCS analysis revealed a U-shaped relationship between mean HbA1c and CI, indicating that both excessively low and high HbA1c levels elevate CI risk. Uncontrolled HbA1c levels (≥ 8%) were also linked to higher CI risk compared to stable HbA1c levels. Maintaining HbA1c levels below 8% may significantly reduce CI risk in T2DM patients, highlighting the importance of personalized glycemic management.
认知障碍（CI）是2型糖尿病（T2DM）患者常见的并发症，但其与长期血糖控制的关系仍不明确。本研究旨在利用中国健康与养老追踪调查（CHARLS）的数据，探讨45岁及以上中国T2DM成年人的平均糖化血红蛋白（HbA1c）水平、HbA1c控制状态、HbA1c波动与CI之间的关联。共纳入797名在2011年至2015年期间进行了HbA1c测量并于2018年进行了认知功能评估的参与者。应用逻辑回归模型和受限立方样条（RCS）分析，并对潜在混杂因素进行了调整。较高的平均HbA1c水平（≥9%）与CI风险增加显著相关，尤其是在整体认知和情景记忆方面（整体认知的比值比为4.03（1.45 - 11.20）；情景记忆的比值比为2.92（1.02 - 8.38））。RCS分析显示平均HbA1c与CI之间呈U形关系，表明过低和过高的HbA1c水平都会增加CI风险。与稳定的HbA1c水平相比，未控制的HbA1c水平（≥8%）也与较高的CI风险相关。将HbA1c水平维持在8%以下可能会显著降低T2DM患者的CI风险，突出了个性化血糖管理的重要性。
