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Low HbA1c predicts frailty status in older adults with type 2 diabetes

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June 7, 2017

In older Japanese adults with type 2 diabetes, low HbA1c is a risk factor for frailty, independent of anemia, according to published findings.

In a retrospective, observational study, the researchers also noted that lower levels for other parameters of metabolic syndrome, including systolic blood pressure, total cholesterol and body weight, were also associated with increased risk for frailty.

“The risk factors in middle age may change from unfavorable to favorable for survival outcome at a certain age,” Toshihiko Yanase, MD, PhD, of the department of endocrinology and diabetes at the Fukuoka University School of Medicine, Japan, and colleagues wrote. “In other words, the risk factors of metabolic syndrome, such as high blood glucose, obesity, high cholesterol and hypertension, in middle age may shift from an unfavorable risk to favorable factors in old age. Such a contradictory shift has been called a metabolic shift and reverse metabolism.”

Yanase and colleagues analyzed data from 132 adults aged at least 65 years with type 2 diabetes being treated at Muta Hospital in Japan (mean age, 78 years; 63 men; mean diabetes duration, 17.6 years; mean HbA1c, 7.3%). Patients were categorized into nine stages of frailty using the clinical frailty scale (CFS). Patients with a score between 1 and 4 were considered not frail; those with a score between 5 and 8 were identified as frail. At the time of frailty evaluation, researchers stratified patients by treatment type: insulin therapy (n = 19), oral agents using sulfonylurea or glinide (n = 44), and diet only and/or oral agents other than sulfonylurea or glinide (n = 69). Follow-up data were obtained 6 months later. Researchers used multiple regression analysis to identify any factors independently affecting CFS.

Within the cohort, 55 patients were categorized as frail; 77 were categorized as not frail.

In multiple regression analysis, researchers found that age, serum albumin level, HDL cholesterol, systolic BP, HbA1c, total cholesterol and body weight were regarded as strong risk factors for frailty; researchers did not observe an association between hemoglobin level and frailty.

When comparing baseline measurements with follow-up data at 6 months, only CFS values increased in the cohort; HbA1c and body weight decreased, and albumin, HDL cholesterol, systolic BP and total cholesterol were unchanged, according to the researchers. There were no differences in the number of antihyperglycemic agents used at baseline and 6 months.

The values of serum albumin, HbA1c and HDL cholesterol reciprocally declined with an increase in CFS score, the researchers wrote, nothing that significant reductions in HbA1c were observed for those with a CFS score between 7 and 8.

“The reciprocal decrease of HbA1c levels with the increase of CFS stage seems to be unrelated to [hemoglobin] levels, since levels of [hemoglobin] were not a significant contributing factor for CFS values as indicated by multiple regression analysis,” the researchers wrote. “Interestingly, despite the slight but significant improvement of HbA1c level after 6 months, CFS values were significantly worse, suggesting again that HbA1c may be a reciprocal indicator of aggravation of frailty in elderly [type 2 diabetes] patients.” – by Regina Schaffer

Disclosure: Yanase reports receiving financial support for research from Boehringer Ingelheim GmbH, Daiichi Sankyo, Eli Lilly Japan, Fujifilm Pharma Co., Ltd., Kowa Company, MSD, Novartis Pharma, Novo Nordisk, Sanofi, Sanwa Chemistry Co., Sumitomo Dainippon and Takeda.

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