IDF21-0206 Historical cardiometabolic trajectories in T2D patients by dementia status in England by sex, ethnicity, and deprivation

Abstract

Background: Type 2 diabetes (T2D) and dementia are costly and rapidly growing epidemics, as well as major contributors to comorbidities and mortality globally. Cardiometabolic factors present as potentially modifiable risks, especially for T2D patients, who have a higher dementia risk, but it is unclear if trends in cardiometabolic levels among those with and without dementia differ by sex, ethnicity, and deprivation. Aim: To explore cardiometabolic trajectories stratified by sex, ethnicity, and deprivation among patients with T2D who developed and who did not develop dementia between 1999 and 2018 in England. Method: Patients with T2D aged >42 years from the Clinical Practice Research Datalink were matched by age (±5 years) and sex, using a 1:4 case-to-control ratio. Outcomes included annual mean levels of eight routinely measured cardiometabolic factors. Study baseline was the date of dementia diagnosis (dementia group), or last contact with healthcare (non-dementia group), and patients were traced backwards. Retrospective cardiometabolic trajectories among patients with T2D were assessed from study baseline up to 19 years before dementia diagnosis (dementia) or last contact with healthcare (no dementia), using multivariable-adjusted multilevel piecewise and non-piecewise growth curve models stratified by sex (male/female), ethnicity (white/non-white), and Index of Multiple Deprivation (lowest/highest). Results: Among 117,730 patients, 23,546 developed dementia during follow-up (median 11 years). Compared to those without dementia, females with dementia had higher SBP between 11-17 years prior to dementia diagnosis, which was not observed in males; while males with dementia had significantly lower SBP from 9 years before diagnosis to baseline, as opposed to 7 years onwards for females. Lower levels of BMI in the dementia group were detected earlier among females (17 years before baseline) vs. males (12 years); white (17 years) vs. non-white (6 years); with no differences in timing by deprivation. Higher levels of FPG were observed earlier in the dementia group compared to non-dementia group for females (from 12 years through to diagnosis) vs. males (2 to 7 years prior to diagnosis); for white (11 years through to diagnosis) vs. non-white (2 to 4 years only); and for those most deprived (3 to 10 years only) vs. least deprived (8 years through to diagnosis). On the contrary, males with dementia had higher HbA1c levels from 8 years to diagnosis vs. females (6 years to diagnosis). While people with dementia who were white had higher HbA1c levels from 9 years prior to diagnosis, no differences were detected by dementia status in the non-white group. Those most deprived with dementia also had higher HbA1c 3-4 years before diagnosis vs. those least deprived (2 years to diagnosis). While some differences were observed by stratification for diastolic blood pressure, cholesterol, high-density lipoprotein, and low-density lipoprotein, absolute differences between dementia and non-dementia groups were generally very small. Discussion: Among women and patients of white ethnicity in a T2D population (19-year follow-up), differences in cardiometabolic factors generally present earlier before dementia diagnosis compared with males and non-white patients, suggesting that future strategies should be tailored for specific subgroups when identifying potential targets for dementia prevention. (Funder: Diabetes UK No. 18/0005851)