Highlights
- •Both high and low HbA1c were associated with higher mortality in elderly diabetics.
- •A 3-fold increase in odd ratio for mortality was noted when the HbA1c was <6.0%.
- •Risk factors for mortality included smoking, low BMI, high LDL, and sulphonylureas.
- •Aggressive glycaemic control should be approached cautiously in the elderly.
Abstract
Objective
To examine the association between the most recent HbA1c values and the mortality
of elderly Type 2 Diabetic (T2DM) patients managed in the public primary care setting
and to explore the associating risk factors.
Design
Retrospective cohort study.
Subjects
All T2DM patients aged 65 or above, who attended a public primary care clinic for
regular follow up from 01/01/2012 to 31/12/2012 were included. Their follow up status
till 31/12/2017 was reviewed. Those who were deceased on or before 31/12/2017 were
matched randomly with controls that were alive in the same cohort for comparison.
Main Outcome Measures
Patients’ demographics, smoking status, duration of T2DM, biochemical parameters including
the most recent HbA1c, lipid profile, renal function test, drug profile, co-morbidities
and all-cause mortality were retrieved from Hospital Authority’s CDARS and CMS systems.
Results
Both high (>8.0%) and low (<6.5%) HbA1c values were associated with increased odd
ratio of all-cause mortality among T2DM elderly patients treated in the primary care.
There was a 3-fold increase in odd ratio when the HbA1c reading was very low (<6.0%).
Associated risk factors for all-cause mortality in elderly T2DM patients included
smoker status, lower BMIs, and higher LDL levels and use of sulphonylureas.
Conclusions
Glycemic target for elderly T2DM patients should be approached cautiously. Over-aggressive
treatment may lead to increased mortality among elderly T2DM patients.
Keywords
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Article info
Publication history
Published online: April 12, 2020
Accepted:
February 29,
2020
Received in revised form:
February 23,
2020
Received:
October 29,
2019
Identification
Copyright
© 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
