Glycosylated hemoglobin and functional decline in community-dwelling nursing home-eligible elderly adults with diabetes mellitus.
OBJECTIVE
To determine whether glycosylated hemoglobin (HbA1c) levels predict functional decline in older adults.


METHODS
Longitudinal cohort study.


METHODS
Community-dwelling, nursing home (NH)-eligible individuals with diabetes mellitus enrolled at On Lok between October 2002 and December 2008 (367 participants, 1,579 HbA1c measurements).


METHODS
On Lok Lifeways, the original model for Programs of All-Inclusive Care for the Elderly.


METHODS
The outcomes were functional decline or death at 2 years. The primary predictor was HbA1c. Age, sex, race and ethnicity, baseline function, comorbid conditions, length of time enrolled at On Lok, insulin use, and clustering of HbA1c within participants were adjusted for with mixed-effects Poisson regression.


RESULTS
Mean age was 80, and 185 participants (50%) were taking insulin. Sixty-three percent of participants experienced functional decline, and 75% experienced death or functional decline during the study period. At 2 years, higher HbA1c was associated with less functional decline or death (P for trend = .006). Accounting for clustering and confounding factors, HbA1c of 8.0% to 8.9% was associated with a lower likelihood (relative risk = 0.88, 95% confidence interval = 0.79-0.99) of functional decline or death than HbA1c of 7.0% to 7.9%.


CONCLUSIONS
In community-dwelling, NH-eligible individuals with diabetes mellitus, HbA1c of 8.0% to 8.9% is associated with better functional outcomes at 2 years than HbA1c of 7.0% to 7.9%, suggesting that the current American Geriatrics Society guideline recommending a HbA1c target of 8.0% or less for older adults with limited life expectancy may be lower than necessary to maintain function.
San Francisco VA PRIME Program, University of California at San Francisco, San Francisco, California 94121, USA.
Celia K
CK
Yau
Catherine
C
Eng
Irena Stijacic
IS
Cenzer
W John
WJ
Boscardin
Kathy
K
Rice-Trumble
Sei J
SJ
Lee
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes; D016012:Poisson Distribution; D012307:Risk Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin