Sugimoto Taiki, Crane Paul K, Choi Seo-Eun, Fujita Kosuke, Gallée Jeanne, Kuroda Yujiro, Lee Michael, Matsumoto Nanae, Nakamura Akinori, Noma Hisashi, Omura Takuya, Onoyama Ayaka, Scollard Phoebe, Uchida Kazuaki, Yokoyama Yoko, Arai Hidenori, Sakurai Takashi
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan.
Department of Medicine, University of Washington, Seattle, Washington, USA.
JAR Life. 2025 Jun 9;14:100016. doi: 10.1016/j.jarlif.2025.100016. eCollection 2025.
To identify subgroups who may be more likely to respond well to a multidomain intervention among older adults with type 2 diabetes.
This study was a secondary analysis of the Japan Multimodal Intervention Trial for Prevention of Dementia. A total 531 participants aged 65-85 years with mild cognitive impairment were randomized into intervention (vascular risk management, exercise, nutritional counseling, and cognitive training) and control (health-related information) groups. The outcome was the change in average Z scores of neuropsychological tests from baseline to 18 months. Interactions between intervention and age (65-74, 75-85 years), memory impairment (amnestic, nonamnestic), HbA1c levels (within, outside target range), or genotype (0, ≥1 ε4 alleles) among participants with diabetes were evaluated using the mixed-effects model for repeated measures.
Among 76 participants with diabetes, a significant age × intervention interaction ( = 0.007) was found, which was driven by benefits in the younger age group (Z score difference: 0.33, 95% CI: 0.09 to 0.55) that were not observed in the older age group. Intervention benefits were also detected in those with HbA1c levels outside the target range (Z score difference: 0.31, 95% CI: 0.06 to 0.56), with HbA1c levels × intervention interaction ( = 0.021). No significant interactions were detected between intervention and memory impairment or genotype.
Multidomain interventions may benefit younger older adults or those with overly strict or lenient HbA1c control; however, these findings need confirmation in future studies.
确定在2型糖尿病老年患者中可能对多领域干预反应更佳的亚组。
本研究是对日本预防痴呆多模式干预试验的二次分析。总共531名年龄在65 - 85岁之间且有轻度认知障碍的参与者被随机分为干预组（血管风险管理、运动、营养咨询和认知训练）和对照组（健康相关信息）。结局指标是从基线到18个月神经心理测试平均Z分数的变化。使用重复测量的混合效应模型评估糖尿病患者中干预与年龄（65 - 74岁、75 - 85岁）、记忆障碍（遗忘型、非遗忘型）、糖化血红蛋白水平（在目标范围内、超出目标范围）或基因型（0个、≥1个ε4等位基因）之间的相互作用。
在76名糖尿病患者中，发现了显著的年龄×干预相互作用（P = 0.007），这是由较年轻年龄组的获益驱动的（Z分数差异：0.33，95%CI：0.09至0.55），而在较年长年龄组中未观察到这种获益。在糖化血红蛋白水平超出目标范围的患者中也检测到了干预获益（Z分数差异：0.31，95%CI：0.06至0.56），存在糖化血红蛋白水平×干预相互作用（P = 0.021）。在干预与记忆障碍或基因型之间未检测到显著的相互作用。
多领域干预可能使年龄较轻的老年人或糖化血红蛋白控制过严或过松的患者获益；然而，这些发现需要在未来研究中得到证实。
