Shortfalls of the use of HbA1C-derived eAG in older adults with diabetes

Munshi, Medha N.; Segal, Alissa R.; Slyne, Christine; Samur, Anıl Aktaş; Brooks, Kelly; Horton, Edward S.

doi:10.1016/j.diabres.2015.07.012

Cited by 26 publications

(19 citation statements)

References 24 publications

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“…However, the use of HbA1c as a marker for glycemic control also has some limitations, especially in patients with medical conditions that impact the red blood cell turnover. These medical conditions are commonly seen in older adults [26]. Second, fasting glucose measurement may show wide within-person variation.…”

Section: Discussionmentioning

confidence: 99%

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

Lee

Han

Huh

2020

Cardiovasc Diabetol

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Background: Growing evidences shows that fasting glucose target should be different according to their health condition in older adults with diabetes. However, there are limited data regarding the relationship between fasting glucose level and health outcomes in Korean older people with diabetes. We aimed to examine the association of fasting glucose with mortality and cardiovascular events in Korean older adults with type 2 diabetes. Methods:From the Korean National Health Insurance System, 227,938 subjects (aged ≥ 65 years) with type 2 diabetes but no history of cardiovascular events (myocardial infarction or stroke) who underwent ≥ 2 health examinations from 2009 to 2010 and who were followed up until 2017 were identified. The primary exposure variable was the mean fasting glucose level. We estimated the relationship between the baseline fasting glucose level and incidences of allcause death and cardiovascular events. Comorbidity load was assessed using the Charlson comorbidity index. Results:Fasting glucose levels and all-cause mortality risk showed a J-shaped relationship regardless of sex and number of comorbidities. Fasting glucose levels associated with the lowest mortality and cardiovascular events were 110-124 and 95-124 mg/dL, respectively. Stratified analysis by comorbidity load using the Charlson comorbidity index revealed higher optimal fasting glucose levels for the lowest cardiovascular events in subjects with Charlson comorbidity index ≥ 3 than in those with Charlson comorbidity index ≤ 2 (119 vs. 112 mg/dL, P = 0.04).Conclusions: J-shaped relationship existed between fasting glucose and all-cause mortality and cardiovascular events in Korean older adults with diabetes. We identified that fasting glucose levels associated with the lowest mortality and cardiovascular events were 110-124 and 95-124 mg/dL respectively. Increased risk of cardiovascular events with low fasting glucose level (< 95 mg/dL) was noted, especially in patients with high comorbidity. These findings suggested that less stringent targets of fasting glucose may be beneficial especially in older adults with multiple comorbidities.

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Section: Discussionmentioning

confidence: 99%

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

Lee

Han

Huh

2020

Cardiovasc Diabetol

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“…Recently, an A1C-derived average blood glucose value has been developed and offered to people with diabetes and health-care providers as a better way to understand glycemic control. While this is a valuable parameter in younger people, this variable and A1C may not accurately reflect continuous glucose monitoring (CGM) measured glucose values or glycemic variability in the older adult (37).…”

Section: Targets For Glycemic Controlmentioning

confidence: 99%

“…In selected cases, continuous glucose monitoring (CGM) may be employed to determine unexpected patterns of hypoglycemia or hyperglycemia, which may result in significant changes in therapy (see below). Since the correlation between A1C values and CGMderived mean glucose values is much less in the elderly than younger patient populations, the 2 measures may be used in a complementary manner to assess glycemic control in the future (37).…”

Section: Monitoring Glycemic Controlmentioning

confidence: 99%

Diabetes in Older People

Meneilly¹,

Knip²,

Miller³

et al. 2018

Canadian Journal of Diabetes

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“…Studies have shown that A1C values in the older population may not reflect the same estimated mean glucose as in the younger population. Possible reasons for this discrepancy are the commonly present comorbidities that impact red cell life span (e.g., anemia, uremia, renal dysfunction, blood transfusion, erythropoietin therapy) (45,46). In addition, A1C level does not reflect glucose excursions and variability.…”

Section: Glycemic Goalsmentioning

confidence: 99%

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

2017

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One of the challenges of managing older adults with diabetes is the individualization of care in people with multiple comorbid conditions. Although macrovascular and microvascular complications of diabetes are well recognized, there is a lack of awareness regarding other conditions such as cognitive dysfunction, depression, and physical disabilities. Cognitive dysfunction is of particular importance because of its impact on self-care and quality of life. In this Perspective, I discuss common and practical questions faced by clinicians managing diabetes in older adults who also have cognitive dysfunction.

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Shortfalls of the use of HbA1C-derived eAG in older adults with diabetes

Abstract: HbA1C-derived eAG values may not accurately reflect CGM-measured mean glucose or MAGE in older adults with diabetes. Wide glucose excursions should be considered and HbA1C should be interpreted cautiously when making treatment changes based on HbA1C.

Cited by 26 publications

References 24 publications

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

Diabetes in Older People

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

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