title: Glycemic control and disability-free survival in hypoglycemic agent-treated community-dwelling older patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Although lower glycated hemoglobin (HbA1c) has been believed to be an important marker of improvement of glycemic control in order to maintain better quality of life for patients with diabetes mellitus, a too low HbA1cmight be harmful in older adults. We investigated whether this was the case with respect to risk of support/care-need certification in community-dwelling older patients with type 2 diabetes mellitus.
  
  
  METHODS
  We analyzed 184 diabetes patients aged 65-94 years receiving glucose-lowering medication/insulin. The end-points were first support/care-need certification and/or death. The relationships between four classes of HbA1cand risk of support/care-need certification and/or death were determined using the Cox proportional hazards regression model.
  
  
  RESULTS
  During 5 years, 42 first support/care-need certifications and 13 deaths occurred. The association of HbA1cwith risk of support/care-need certification after adjustment for age, sex and confounding variables was J-shaped, with the nadir at an HbA1clevel of 6.5 to <7.0%, and with an increased risk of support/care-need certification (HR 3.45, 95% CI 1.02-11.6, P = 0.046) at an HbA1clevel of <6.0% compared with the nadir. When compared with patients with HbA1c≥6.0%, those with HbA1c<6.0% showed a higher risk of support/care-need certification as a result of dementia (HR 12.5, 95% CI 3.00-52.2, P = 0.001), but not as a result of arthralgia/fracture, stroke or other disorders.
  
  
  CONCLUSIONS
  These observations show that a too low HbA1cmight be associated with a later risk of incident disability as a result of dementia in community-dwelling older diabetes patients. Geriatr Gerontol Int 2017; 17: 1858-1865.
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Tazuo
authors.initials: T
authors.lastname: Okuno
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Taroh
authors.initials: T
authors.lastname: Himeno
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Kumie
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: School of Nursing, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yano
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iritani
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Okuro
authors.affiliation: Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Morimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D057187:Independent Living; D008297:Male; D012306:Risk
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: certification; dementia; diabetes mellitus; elderly; glycated hemoglobin