title: Association between different hemoglobin A1c levels and clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus.
abstract: OBJECTIVE
  New guidelines recommend a target glycated hemoglobin (HbA1c) of 7.5% to 8.0% in elderly persons with type 2 diabetes mellitus (T2DM), but real-world data regarding outcomes associated with different HbA1c levels in the elderly are limited. This study assessed outcomes and their association with defined HbA1c thresholds and age ranges in insulin-treated, elderly, patients with T2DM in long-term care (LTC).
  
  
  METHODS
  Retrospective analysis of medical charts and the Minimum Data Set (MDS) for the period September 2010 through September 2011.
  
  
  METHODS
  A total of 117 nursing homes in the United States.
  
  
  METHODS
  Eligible patients had resided in LTC for 3 months or more, had at least 1 full MDS assessment, 2 or more records of insulin dispensing with no pump use, and 1 or more HbA1c measurements.
  
  
  METHODS
  Outcomes that were measured included hypoglycemia, ketoacidosis, infections, falls, hospitalization, and emergency room (ER) visits.
  
  
  RESULTS
  A total of 583 patients were included (mean age 78.9 years, mean chart observation length 55 days). In all groups, hypoglycemia was lowest in patients with an HbA1c level higher than 9.0%. In patients 75 years or older, infection rates were highest when HbA1c levels were higher than 9.0%. Falls increased by HbA1c level in patients aged 65 to 74 years, but decreased by HbA1c levels in patients 85 years or older. Ketoacidosis, hospitalization, and ER visits were low in all groups.
  
  
  CONCLUSIONS
  These data suggest that better glycemic levels may not necessarily be associated with better clinical outcomes, and different age groups may exhibit different patterns, thereby supporting the call for individualized glycemic control among elderly patients.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC. Electronic address: kldavis@rti.org.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.affiliation: Sanofi US, Inc, Bridgewater, NJ.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC.
authors.forename: Juliana L
authors.initials: JL
authors.lastname: Meyers
authors.affiliation: AnalytiCare, LLC, Glenview, IL.
authors.forename: Brett S
authors.initials: BS
authors.lastname: Kilpatrick
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL.
authors.forename: Naushira
authors.initials: N
authors.lastname: Pandya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Elderly; hemoglobin A1c; long-term care; type 2 diabetes mellitus