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HbA1c and mortality in insulin-treated older people with type 2 diabetes explored

By Editor
16th January 2019
Older people, Type 2 diabetes

Older people with type 2 diabetes on insulin with HbA1c levels outside 6.5 to 7.4% have an increased of all-cause mortality, according to research.

Researchers from the University of Nottingham also reported that there was a “markedly excess risk with HbA1c > 11%” following the study of 4,589 people.

According to the researchers, the findings, published in the the official journal of the British Geriatrics Society Age and Ageing, support “the need for individualisation of care and suggests better outcomes with HbA1c levels around 6.5–7.4%”.

They also support the results of a similar study reported by the DT published in The Lancet Diabetes and Endocrinology last summer by Professors Angus Forbes and Alan Sinclair, which showed high and low levels of glycaemic control and high HbA1c variability were associated with increased mortality in older people with diabetes, mainly type 2 diabetes, on a wide range of treatments.

In this new study, the research team set out to explore the relationship between HbA1c and cardiovascular morbidity and all-cause mortality among older insulin-treated people with type 2 diabetes.

Data was pulled from 532 GP practices through the Health Improvement Network (THIN) database. Cox proportional hazard models and Kaplan–Meier estimators were fitted to derive the hazards of all-cause mortality by HbA1c categories (<6.5, 6.5–7.4, 7.5–8.4, 8.5–9.4, 9.5–10.4, 10.5–11.4%; and 11.5% and above) after five years of follow-up following insulin initiation.

Summarising the results, the researchers said: “We observed a U-shaped relationship between all-cause mortality and HbA1c, with the lowest risk seen in the HbA1c range of 6.5–7.4% and marked increased in risk with HbA1c > 11%. The highest mortality risks of 31 and 40% were significantly associated with the lowest (<6.5%) and highest (11.5% and above) HbA1c categories: aHR: 1.31; (95%CI: 1.10–1.56; P = 0.002) and aHR: 1.40; (95%CI: 1.01–1.96; P = 0.039), respectively.”

They concluded: “Both low and high HbA1c were associated with increased all-cause mortality, among older patients with insulin-treated T2D. This cohort study supports the need for individualisation of care and suggests better outcomes with HbA1c levels around 6.5–7.4% and markedly excess risk with HbA1c > 11%.”

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