Identifying older diabetic patients at risk of poor glycemic control.
BACKGROUND
Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients.


METHODS
A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population.


RESULTS
Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia > or = 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population.


CONCLUSIONS
A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control.
1Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy. raffaele_antonelli@rm.unicatt.it
Raffaele Antonelli
RA
Incalzi
Andrea
A
Corsonello
Claudio
C
Pedone
Francesco
F
Corica
Luciana
L
Carosella
Bruno
B
Mazzei
Francesco
F
Perticone
PierUgo
P
Carbonin