Smartest Doc
Glycosylated Hemoglobin and Functional Decline in Community-Dwelling Nursing Home-Eligible Elderly Adults with Diabetes Mellitus
Journal of the American Geriatrics Society, 06/20/2012
Yau CK et al. – In community–dwelling, nursing home (NH)–eligible individuals with diabetes mellitus, HbA1c of 8.0% to 8.9% is associated with better functional outcomes at 2 years than HbA1c of 7.0% to 7.9%, suggesting that the current American Geriatrics Society guideline recommending a HbA1c target of 8.0% or less for older adults with limited life expectancy may be lower than necessary to maintain function.
Methods- Longitudinal cohort study.
- Community-dwelling, nursing home (NH)-eligible individuals with diabetes mellitus enrolled at On Lok between October 2002 and December 2008 (367 participants, 1,579 HbA1c measurements).
- The outcomes were functional decline or death at 2 years.
- The primary predictor was HbA1c.
- Age, sex, race and ethnicity, baseline function, comorbid conditions, length of time enrolled at On Lok, insulin use, and clustering of HbA1c within participants were adjusted for with mixed-effects Poisson regression.
- Mean age was 80, and 185 participants (50%) were taking insulin.
- Sixty-three percent of participants experienced functional decline, and 75% experienced death or functional decline during the study period.
- At 2 years, higher HbA1c was associated with less functional decline or death (P for trend = .006).
- Accounting for clustering and confounding factors, HbA1c of 8.0% to 8.9% was associated with a lower likelihood (relative risk = 0.88, 95% confidence interval = 0.79–0.99) of functional decline or death than HbA1c of 7.0% to 7.9%.