V-shaped relationship between HbA1c and all-cause mortality in the elderly with type 2 diabetes |
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| Affiliation: | 1. Diabetes Center, Aizawa Hospital, Matsumoto, Japan;2. Rehabilitation Center, Aizawa Hospital, Matsumoto, Japan;3. Data Science, Clinical Research Department, Kissei Pharmaceutical, Tokyo, Japan;4. Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan;5. Ohike Clinic, Matsumoto, Japan;6. Toba Clinic, Chikuhoku, Nagano-prefecture, Japan;7. Yazaki Clinic, Azumino, Japan;8. Yokoyama Clinic, Yamagata, Nagano-prefecture, Japan;9. Suzuki Clinic, Matsumoto, Japan;10. Shironishi Hospital, Matsumoto, Japan;11. Division of Diabetes, Endocrinology and Metabolism, Shinshu University School of Medicine, Matsumoto, Japan;12. Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Japan;1. San Ignacio Health Centre, Bilbao-Basurto Integrated Health Organisation, Member of the Working Groups for the Care for Elderly People and Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC), Spain;2. Bizkaia Unit for Multi-professional Training in Family and Community Care, Member of the Working Groups for the Care for Elderly People and Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC), Spain;3. Sub-Directorate General of Health Promotion and Epidemiology, Directorate General of Public Health, Quality and Innovation, Spanish Ministry of Health, Social Services and Equality, Spain;4. Albacete University Hospital, and Associate Professor, Faculty of Medicine, University of Castilla-La Mancha, Spain;1. Department of Emergency, Nantong First People''s Hospital, Nantong, PR China;2. Nantong University, Nantong, PR China;1. Department of Neurology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13130 Hämeenlinna, Finland;2. Medical School, Tampere University, Tampere, Finland;3. Department of Neurosurgery, Tampere University Hospital, Tampere, Finland;4. Research Unit, Pirkanmaa Hospital District, Tampere, Finland;5. Tampere School of Public Health, University of Tampere, Tampere, Finland;6. Department of Pharmacy, University of Eastern Finland, Kuopio, Finland;7. Science Service Center, Kuopio University Hospital, Kuopio, Finland;8. National Institute for Health and Welfare, Helsinki, Finland;1. Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;2. Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;3. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan;4. Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan;5. Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;6. Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;7. Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan |
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| Abstract: | PurposeThe optimal glycemic target for elderly patients with diabetes has not been established. The purpose of this study was to elucidate relationship between HbA1c and mortality in elderly patients with diabetes.SubjectsThree hundred consecutive elderly (≥ 65 yrs) patients with type 2 diabetes mellitus admitted for control of hyperglycemia between 2002 and 2010 were registered. Upon mortality survey at the end of 2012, 201 (70%) of them were traceable (men/women 121/80, mean age 71 yrs, duration of diabetes 11 yrs and HbA1c 9.9%). The analysis took account of the following baseline information: gender, age, duration of diabetes, HbA1c, body mass index, systolic blood pressure, eGFR, urinary albumin excretion, serum lipid levels and use of insulin and oral hypoglycemic agents. The follow-up HbA1c was also recorded.ResultsThe mean follow-up period was 5.7 yrs and 45 of the patients have died. The mortality hazard as a function of the baseline HbA1c quartile was significantly V-shaped with the nadir in quartile 2 (HbA1c 8.5–9.4%) (P = 0.02), and this relationship remained significant after adjustment for the confounders such as estimated glomerular filtration rate and insulin use. The follow-up HbA1c was 7.7 ± 1.6% and not significantly related to mortality.Discussion/ConclusionThere was a V-shaped relationship between baseline HbA1c and all-cause mortality in elderly patients with insufficiently controlled glycemia. The nadir was in Q2 in which the HbA1c value was 8.5–9.4%. No significant relationship was found between the follow-up HbA1c and mortality. Further studies are needed to clarify the relationship between HbA1c and mortality in the elderly. |
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| Keywords: | Mortality Elderly HbA1c |
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