title: Tighter glycemic control is associated with ADL physical dependency losses in older patients using sulfonylureas or mitiglinides: Results from the DIMORA study.
abstract: BACKGROUND
  There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD.
  
  
  METHODS
  We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses.
  
  
  RESULTS
  Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050).
  
  
  CONCLUSIONS
  Tighter glycemic control was associated with ADL physical dependency losses, especially in those using sulfonylureas and mitiglinides.
authors: Alzheimer's Disease Clinic, ASL Frosinone, Atina, Italy. Electronic address: angela_abbatecola@yahoo.com.
authors: Angela M
authors: AM
authors: Abbatecola
authors: University of Turin, Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy.
authors: Mario
authors: M
authors: Bo
authors: Division of Geriatrics, Hospital of Valdagno, Italy.
authors: Fabio
authors: F
authors: Armellini
authors: Azienda Sanitaria Provinciale di Messina, Messina, Italy.
authors: Ferdinando
authors: F
authors: D'Amico
authors: University of Aquila, Aquila, Italy.
authors: Giovambattista
authors: G
authors: Desideri
authors: Sapienza University of Rome, Rome, Italy.
authors: Paolo
authors: P
authors: Falaschi
authors: Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
authors: Antonio
authors: A
authors: Greco
authors: Fondazione Brescia Solidale, Brescia, Italy.
authors: Gianbattista
authors: G
authors: Guerrini
authors: Italian National Research Center on Aging (INRCA), Scientific Direction, Ancona, Italy.
authors: Fabrizia
authors: F
authors: Lattanzio
authors: ASL Napoli 1, Naples, Italy.
authors: Clelia
authors: C
authors: Volpe
authors: Second University of Naples, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Naples, Italy.
authors: Giuseppe
authors: G
authors: Paolisso
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054833:Isoindoles / Q000627:therapeutic use*; D008297:Male; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D054833:Isoindoles; D013453:Sulfonylurea Compounds; C087255:mitiglinide
keywords: Aging; Anti-diabetic oral agents; Disability; Glycated hemoglobin; Type 2 diabetes