American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality
Research Design and Methods: Prospective cohort analysis of older adults aged 66-90 years with diagnosed diabetes in the Atherosclerosis Risk in Communities (ARIC) Study.
Results: In the 1841 participants (56% were women, 29% Black), 32% were classified as healthy, 42% had complex/intermediate, and 27% had very complex/poor health. Over a median 6-year follow-up, there were 409 (22%) deaths and 4130 hospitalizations (median, 25th-75th: 1, 0-3 per person). In the very complex/poor category, individuals with A1C≥8% (versus A1C<7%) had higher mortality risk (HR 1.76, 95%CI:1.15-2.71), even after adjustment for glucose-lowering medication use. Within the very complex/poor health category, individuals with A1C≥8% had more hospitalizations (incidence rate ratio (IRR) 1.41, 95%CI:1.03-1.94) than those with A1C<7%. In the complex/intermediate group, individuals with A1C≥8% (versus A1C<7%) had more hospitalizations even with adjustment for glucose-lowering medication use [IRR 1.64 (1.21-2.24)]. Results were similar, but imprecise, when the analysis was restricted to insulin or sulfonylurea users (n=663).Conclusions: There were substantial differences in mortality and hospitalizations across ADA health status categories, but older adults with A1C<7% were not at elevated risk, regardless of health status. Our results support the 2021 ADA guidelines and indicate that <7% is a reasonable treatment goal in some older adults with diabetes.