title: New-onset diabetes in elderly subjects: association between HbA1c levels, mortality, and coronary revascularization.
abstract: OBJECTIVE
  New-onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk.
  
  
  METHODS
  The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel. Included in the study were subjects 65 years of age and above with new-onset DM. The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting.
  
  
  RESULTS
  Participants (n = 2,994) were stratified into four groups according to their mean HbA1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5-6.99% [48-52 mmol/mol], 7-7.49% [53-57 mmol/mol], and ≥7.5% [58 mmol/mol]). During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization. An HbA1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2-1.8], P < 0.0001). This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins. Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA1c 6.5-6.99% (48-52 mmol/mol) (HR 1.6 [1.01-2.4], P < 0.05) and lowest in patients with HbA1c ≥7.5% (58 mmol/mol).
  
  
  CONCLUSIONS
  An HbA1c level >7.5% (58 mmol/mol) is associated with increased risk for all-cause mortality and with a lower revascularization rate in elderly patients with new-onset DM.
authors.affiliation: Corresponding author: Orit Twito, orit.twito@clalit.org.il.
authors.forename: Orit
authors.initials: O
authors.lastname: Twito
authors.forename: Ella
authors.initials: E
authors.lastname: Ahron
authors.forename: Anat
authors.initials: A
authors.lastname: Jaffe
authors.forename: Shani
authors.initials: S
authors.lastname: Afek
authors.forename: Efrat
authors.initials: E
authors.lastname: Cohen
authors.forename: Martine
authors.initials: M
authors.lastname: Granek-Catarivas
authors.forename: Pinchas
authors.initials: P
authors.lastname: Klein
authors.forename: Doron
authors.initials: D
authors.lastname: Hermoni
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000601:surgery*; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007557:Israel; D008297:Male; D012306:Risk
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human