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Article Dans Une Revue International Journal of Clinical Practice Année : 2011

Glycemic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20)

Résumé

Aims Studies on macrovascular consequences of glucose control in elderly patients (>75 years) with type 2 diabetes mellitus (T2DM) are lacking. The present study aimed to investigate the relationship between HbA1c and mortality in this specific population. Methods Between 1998 and 1999, 374 primary care patients with T2DM aged older than 75 years participated in the ZODIAC study, a prospective observational study. Early 2009, data on mortality were collected. Updated means for annually measured HbA1c values were calculated after a follow-up time of 10 years. Updated mean HbA1c was used as a time-dependent covariate in a Cox proportional hazard model. Main outcome measures were all-cause and cardiovascular disease (CVD) mortality. Analyses were performed in strata according to diabetes duration (<5, 5-11 and ≥11 years). Results In the group with a diabetes duration <5 years, an increase of 1% in the updated mean HbA1c level was associated with an increase in all-cause and CVD mortality risk of 51% (95%CI 17%-95%) and 72% (95%CI 19%-148%), respectively. Glycemic control was not related to mortality for patients with a diabetes duration ≥5 years. Conclusions Poor glycemic control is related to increased all-cause and CVD mortality in patients >75 years with T2DM of short duration (<5 years). Discussion Because of the observational study design, our results should be interpreted with caution. Nevertheless, they are suggestive that improving glycemic control may be beneficial in elderly patients with T2DM, especially in those with recently diagnosed T2DM. Randomised controlled trials are necessary to investigate whether this holds true.

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Dates et versions

hal-00623802 , version 1 (15-09-2011)

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Kornelis van Hateren, Gijs Landman, Nanne Kleefstra, Iefke Drion, Klaas Groenier, et al.. Glycemic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20). International Journal of Clinical Practice, 2011, 65 (4), pp.415. ⟨10.1111/j.1742-1241.2010.02596.x⟩. ⟨hal-00623802⟩

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