Association of hemoglobin A1c (A1c) stability with mortality and diabetes complications in older adults with diabetes
Authors' conclusion
In older adults with diabetes, mortality and macrovascular complications are associated with increased time above and below individualized A1c target ranges. Higher A1c TIR may identify patients with lower risk of adverse outcomes.
Study context
- Population
- Veterans with diabetes and ≥4 A1c tests during a 3-year baseline, 2004–2016; mean age 76.9 years (SD 5.7)
- Participants
- 397,634 veterans
- Exposure
- A1c time below, above or mixed vs ≥60% time in individualised target range
- Outcome
- Mortality, macrovascular and microvascular complications
- Follow-up
- Average 5.5 years
Methodological detailsobservational
- Observational
Main finding
As reported in the abstract
Mortality
Each group vs ≥60% TIRHazard ratio (95% CI)
≥60% TBR
1.12(1.11–1.14)
≥60% TAR
1.10(1.08–1.12)
Mixed
1.06(1.04–1.07)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Microvascular complications≥60% TBRvs ≥60% TIR | 0.97 (0.95–1.00) | |
| Microvascular complications≥60% TARvs ≥60% TIR | 1.11 (1.08–1.14) | |
| 0.512Hazard ratio (log scale) |
| Outcome | Estimate |
|---|---|
| Macrovascular complications≥60% TBR vs ≥60% TIR | 1.04 (95% CI 1.01–1.06) |
| Macrovascular complications≥60% TAR vs ≥60% TIR | 1.06 (95% CI 1.03–1.09) |
Sensitivity analyses
- Results similar with higher time in range (TIR) thresholds, shorter follow-up and competing risk of mortality
Original publication
Association of hemoglobin A1c stability with mortality and diabetes complications in older adults with diabetes. BMJ Open Diabetes Res Care. Published 6 April 2023. doi:10.
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