AIMS: Building upon established short-term benefits, this study aimed to assess Tai Chi's durability for preserving global and domain-specific cognition in older adults (>= 60 years) with type 2 diabetes and mild cognitive impairment (T2D-MCI), compared to fitness walking and health education. METHODS: Participants (n = 328) were randomized 1:1:1 to Tai Chi, fitness walking, or health education groups, completing 24-week interventions. Cognitive outcomes-global cognition (Montreal Cognitive Assessment, MoCA), executive function, attention, visuospatial ability, and language fluency-were evaluated at baseline, 24 weeks (post-intervention), 36 weeks, and 2 years. Linear mixed models analyzed group-by-time interactions, while time-dependent Cox regression quantified minimal clinically important difference (MCID) attainment (MoCA improvement >= 4 points). RESULTS: At 2-year follow-up, linear mixed models revealed significant group-by-time interactions for MoCA (p < 0.001). The Tai Chi group showed greater MoCA improvement versus health education (mean difference 1.8, 95% CI 0.3 to 3.3, p = 0.016). Crucially, 49.8% of Tai Chi practitioners achieved MCID-nearly double the probability of health education (HR 2.0, 95% CI 1.4 to 2.8, p < 0.001) and exceeding fitness walking (HR 1.7, 95% CI 1.2 to 2.4; p = 0.005). Tai Chi selectively enhanced executive function (shorter Stroop reaction timesversus health education, p < 0.05; fewer color-word errorsversus fitness walking, p = 0.049) and visuospatial ability (higher Rey-Osterrieth copy scoresversus health education, p = 0.034). CONCLUSIONS: Tai Chi provides superior long-term preservation of global cognition and executive/visuospatial function in T2D-MCI older adults, with nearly 50% achieving clinically meaningful cognitive improvement. As a scalable mind-body intervention, it warrants integration into geriatric preventive care to mitigate dementia risk.

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