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NHANES: HbA1c associated with mortality risk in older adults
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In older adults, an HbA1c greater than 8% was associated with increased risks for all-cause, cardiovascular and cancer-related deaths, according to an analysis of National Health and Nutrition Examination Survey data.
“Few studies have had sufficient data to assess the association between HbA1c and mortality in an exclusive sample of adults aged 65 years and older with and without diabetes, a population at potentially higher risk of adverse diabetes-related complications,” Priya Palta, PhD, associate professor in the department of epidemiology at the Johns Hopkins School of Public Health, and colleagues wrote. “Largely, data on the benefits and outcomes associated with HbA1c lowering remain heterogeneous, particularly among populations of older adults. Therefore, more studies of the HbA1c–mortality relationship are needed to affirm the current clinical practice recommendations and guidelines related to the care of diabetes for older adults.”
Palta and colleagues analyzed data from 7,333 adults aged at least 65 years participating in NHANES III (1988-1994) and continuous NHANES (1999-2004), as well as their linked mortality data through December 2011. Researchers used Cox proportional hazards models to calculate HRs for the association of HbA1c level with all-cause and cause-specific mortality (CVD, cancer and non-CVD/noncancer), separately for adults with and without diabetes.
During a mean of 8.9 years, 4,729 adults died (1,262 from CVD, 850 from cancer and 2,617 from non-CVD/noncancer causes). Compared with those with well-controlled diabetes (HbA1c < 6.5%), the HR for all-cause-related mortality was greatest for adults with diabetes with an HbA1c of at least 9% (HR = 1.8; 95% CI, 1.3-2.6), followed by those with an HbA1c of at least 8% (HR = 1.6; 95% CI, 1.02-2.6). All-cause mortality also was greater for those with undiagnosed diabetes with an HbA1c of at least 6.5% vs. those without diabetes (HR = 1.3; 95% CI, 1.03-1.8).
Researchers also found that elevated risk for CVD-related mortality was significant only among adults with diabetes and an HbA1c of at least 9% (HR = 3.2; 95% CI, 1.8-5.7) vs. adults without diabetes.
“In general, data on outcomes associated with glycemic control in older adults with diabetes are scant,” Jessica Yeh, PhD, associate director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins University, Baltimore, told Endocrine Today. “In the setting of older adults, the decision to aggressively treat an individual patient’s glucose levels is variable and cannot be based solely on findings from studies of general populations like ours. However, most studies so far affirm what has been put forth by the ADA, AGS, AACE, and EASD: that glycemic goals be individualized depending on the patient goals, life expectancy, and overall health status.”
“With the advancement in diabetes treatment, we think future research should study the relationship between level of HbA1c control and quality of life, functionalities, geriatric syndrome, and health care utilizations (e.g. hospitalization due to complications) in older adults,” Yeh said.– by Regina Schaffer
For more information:
Jessica Yeh, PhD, can be reached at the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University, 2024 E. Monument St, Suite 2-500, Baltimore, Maryland 21205; email: hyeh1@jhmi.edu
Disclosure: The researchers report no relevant financial disclosures.
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