Hemoglobin A1c (A1c) time-in-range, mortality, and diabetes complications in older adults with diabetes
Authors' conclusion
A1c stability within patient-specific target ranges is associated with a lower risk of major adverse outcomes among older adults with diabetes.
Study context
- Population
- Patients with diabetes aged ≥65 years, Veterans Affairs (VA) and Kaiser Permanente (KP), 2004–2018, ≥4 A1c tests during a 3-year baseline; mean age 74.3 years (SD 5.8) VA and 72.3 years (SD 5.7) KP
- Exposure
- Lower vs higher individualized HbA1c time-in-range
- Outcome
- Mortality, cardiovascular and microvascular outcomes
Methodological detailsobservational, instrumental variable models, two health systems (VA and KP)
- Observational
- Instrumental variable models
- Two health systems (VA and KP)
Main finding
As reported in the abstract
Mortality (VA patients)
Lower A1c TIR vs Higher A1c TIRHazard ratio (95% CI)
VA patients
1.22(1.20–1.23)
KP patients
1.36(1.27–1.45)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CV outcomesVA patients | 1.10 (1.07–1.13) | |
| 0.512Hazard ratio (log scale) |
CV outcomes
- KP: Instrumental variable (IV) models showed associations with increased mortality and CV outcomes
HbA1c time below and above range
- In both VA and KP, greater A1c time below and time above range were associated with increased mortality
Original publication
Hemoglobin A1c time-in-range, mortality, and diabetes complications in older adults with diabetes. BMJ Open Diabetes Res Care. Published 4 November 2025. doi:10.
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