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Glycaemic control in later life: Impact on mortality

Here, investigators analysed data from participants in the US NHANES (National Health and Nutrition Examination Survey) who were ≥65 years of age and found that those who had an HbA1c ≥64 mmol/mol (8%) had an increased risk of mortality. They found that all-cause mortality risk was 60% higher in people with diabetes who had an HbA1c between 64 mmol/mol and 74 mmol/mol (8.9%), compared with those with diabetes and an HbA1c <48 mmol/mol (6.5%).

By Colin Kenny, GP, Dromore

NHANES is a programme of studies designed to assess the health and nutritional status of adults and children in the US. Here, researchers analysed data from 7333 participating adults aged at least 65 years who were enrolled in NHANES III (1988–94) and continuous NHANES (1999–2004), following them up for a mean of 8.9 years.

In all, 4729 people died (1262 from cardiovascular disease [CVD], 850 from cancer and 2617 from non-CVD and non-cancerous causes). Compared with those with well-controlled diabetes (HbA1c <48 mmol/mol [6.5%]), all-cause mortality was greatest for adults with diabetes with an HbA1c ≥75 mmol/mol (9%) followed by those with an HbA1c ≥64 mmol/mol (8%). The researchers suggested that, in light of the conflicting evidence base, older adults should be given individualised glycaemic targets depending on demographics, duration of diabetes and comorbidities.

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