High blood glucose associated with excess mortality in older people

By Colin Kenny, Editor – Diabetes Distilled
 
In this study investigators wanted to examine the relationship between HbA_1c, cardiovascular morbidity and all-cause mortality in older patients using insulin to treat type 2 diabetes, after adjusting for other factors. They examined a large GP database to gather information on patients aged over 65 treated with insulin. Both low and high HbA_1cwere found to be associated with increased all-cause mortality, with the greatest increase in risk seen at HbA_1c>96 mmol/mol (>11%). The lowest risk, in this U-shaped relationship, was seen in the 47.5–57.4 mmol/mol (6.5–7.4%) HbA_1crange.

High and low levels of HbA_1care associated with increased mortality in older adults with type 2 diabetes. In this new study, the research team explored the relationship between HbA_1c, cardiovascular morbidity and all-cause mortality among older insulin-treated people with type 2 diabetes. Data were extracted from 532 GP practices from The Health Improvement Network (THIN) database. Investigators identified 4589 adults aged over 65 with type 2 diabetes who had been on insulin treatment for longer than 5 years.

The investigators noted a U-shaped relationship between all-cause mortality and HbA_1c, with the lowest risk being in the 47.5–57.4 mmol/mol (6.5–7.4%) HbA_1crange. Risk increased markedly at HbA_1c<47.5 mmol/mol (<6.5%) and >96 mmol/mol (>11%), which equated to a 31% and 40% risk of all-cause mortality, respectively. 

This study supports the need for individualised care. The results suggest better outcomes with HbA_1clevels around 47.5–57.4 mmol/mol (6.5–7.4%) and that HbA_1c>96 mmol/mol (>11%) is associated with an excessive risk of mortality. 

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