In:
Journal of the American Geriatrics Society, Wiley
Abstract:
For older adults with type 2 diabetes (T2D) treated with insulin or sulfonylureas, Endocrine Society guideline recommends HbA1c between 7% to 〈 7.5% for those in good health, 7.5% to 〈 8% for those in intermediate health, and 8% to 〈 8.5% for those in poor health. Our aim was to examine associations between attained HbA1c below, within (reference), or above recommended target range and risk of complication or mortality. Methods Retrospective cohort study of adults ≥65 years old with T2D treated with insulin or sulfonylureas from an integrated healthcare delivery system. Cox proportional hazards models of complications during 2019 were adjusted for sociodemographic and clinical variables. Primary outcome was a combined outcome of any microvascular or macrovascular event, severe hypoglycemia, or mortality during 12‐month follow‐up. Results Among 63,429 patients (mean age: 74.2 years, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health ( n = 16,895) whose HbA1c was above (HR 1.97, 95% CI 1.62–2.41) or below (HR 1.29, 95% CI 1.02–1.63) compared to within recommended range. Among those in intermediate health ( n = 30,129), complication risk was increased for those whose HbA1c was above (HR 1.45, 95% CI 1.30–1.60) but not those below the recommended range (HR 0.99, 95% CI 0.89–1.09). Among those in poor health ( n = 16,405), complication risk was not significantly different for those whose HbA1c was below (HR 0.98, 95% CI 0.89–1.09) or above (HR 0.96, 95% CI 0.88–1.06) recommended range. Conclusions For older adults with T2D in good health, HbA1c below or above the recommended range was associated with significantly elevated complication risk. However, for those in poor health, achieving specific HbA1c levels may not be helpful in reducing the risk of complications.
Type of Medium:
Online Resource
ISSN:
0002-8614
,
1532-5415
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2040494-3
