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Preventing misdiagnosis of diabetes in the elderly

By Colin Kenny, Editor – Diabetes Distilled

Investigators examining increased HbA1c levels in older people without diabetes have found a positive association between HbA1c concentration and age in two independent population-based cohorts. This increase was observed equally in lean, overweight and obese individuals. Investigators used their findings to propose age-dependent reference values for HbA1c and suggested that clinicians be made aware of this age-related increase in HbA1c that is independent of diabetes. They propose that age-dependent reference intervals be used to improve patient care and the diagnosis of diabetes.​

German investigators were aware of reports that raised levels of HbA1c occur in older people without diabetes, but to confirm this they examined two population-based cohorts in which common risk factors were being recorded. They found over 8000 patients without diabetes or hypertension, matched them to controls and compared the cohorts with respect to age-specific changes in HbA1c levels.
In both study populations there was an increase in HbA1c with increasing age, confirming previous observations that HbA1c increases with age in people without diabetes. This association between HbA1c and age was independent of BMI. The investigators suggested that there should be HbA1c reference ranges for people in later life. They believe that this will improve patient care and reduce the risk of diabetes misdiagnosis and overtreatment in clinical practice. 

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