scholarly journals American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality

2021 ◽  
Author(s):  
Mary R. Rooney ◽  
Olive Tang ◽  
Justin B. Echouffo Tcheugui ◽  
Pamela L. Lutsey ◽  
Morgan E. Grams ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Glycemic Control ◽  
American Diabetes Association ◽  
Cohort Analysis ◽  
Medication Use ◽  
Poor Health ◽  
Glucose Lowering ◽  
Atherosclerosis Risk In Communities ◽  
Intermediate Group

<u>Objective:</u> The 2021 American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults based on comorbid health status. We assessed risk of mortality and hospitalizations in older adults with diabetes across glycemic control (A1C <7%, 7-<8%, ≥8%) and ADA-defined health status (healthy, complex/intermediate, very complex/poor) categories. <p><u>Research Design and Methods:</u> Prospective cohort analysis of older adults aged 66-90 years with diagnosed diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. </p> <p><u>Results:</u> In the 1841 participants (56% were women, 29% Black), 32% were classified as healthy, 42% had complex/intermediate, and 27% had very complex/poor health<a>. Over a median 6-year follow-up, there were 409 (22%) deaths and 4130 hospitalizations (median, 25<sup>th</sup>-75<sup>th</sup>: 1, 0-3 per person). In the very complex/poor category, individuals with A1C≥8% (versus A1C<7%) had higher mortality risk (HR 1.76, 95%CI:1.15-2.71), even after adjustment for glucose-lowering medication use. Within the very complex/poor health category, individuals with A1C≥8% had more hospitalizations (incidence rate ratio (IRR) 1.41, 95%CI:1.03-1.94) than those with A1C<7%. In the complex/intermediate group, individuals with A1C≥8% (versus A1C<7%) had more hospitalizations even with adjustment for glucose-lowering medication use [IRR 1.64 (1.21-2.24)]. Results were similar, but imprecise, when the analysis was restricted to insulin or sulfonylurea users (n=663).</a></p> <u>Conclusions:</u> There were substantial differences in mortality and hospitalizations across ADA health status categories, but older adults with A1C<7% were not at elevated risk, regardless of health status. Our results support the 2021 ADA guidelines and indicate that <7% is a reasonable treatment goal in some older adults with diabetes.

1398-P: Mortality Implications of Comorbid Health Status in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1398-P
Author(s):  
MARY R. ROONEY ◽  
OLIVE TANG ◽  
B. GWEN WINDHAM ◽  
JUSTIN B. ECHOUFFO TCHEUGUI ◽  
PAMELA LUTSEY ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality

Diabetes Care ◽  
2021 ◽  
pp. dc203045
Author(s):  
Mary R. Rooney ◽  
Olive Tang ◽  
Justin B. Echouffo Tcheugui ◽  
Pamela L. Lutsey ◽  
Morgan E. Grams ◽  
...  
Keyword(s):  
Older Adults ◽  
Glycemic Control ◽  
American Diabetes Association

scholarly journals Frailty Indexed Classification of Bangladeshi Older Adults’ Physio-psychosocial Health and Associated Risk Factors- A Cross-sectional Survey Study

2020 ◽  
Author(s):  
Mohammad Meshbahur Rahman ◽  
Mohammad Hamiduzzaman ◽  
Saleha Akter ◽  
Zaki Farhana ◽  
Mohammad Kamal Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Health Status ◽  
Family Income ◽  
Psychosocial Health ◽  
Poor Health ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Study Results ◽  
Associated Risk Factors

Abstract Background: Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults’ physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors.Methods: A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant’s health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted.Results: The participants’ mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95 % CI: 2.26–7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR=1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p<0.011) of frailty (poor health).Conclusion: Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

scholarly journals Poor health status, inappropriate glucose-lowering therapy and high one-year mortality in geriatric patients with type 2 diabetes

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Antoine Christiaens ◽  
Benoit Boland ◽  
Marie Germanidis ◽  
Olivia Dalleur ◽  
Séverine Henrard
Keyword(s):  
Health Status ◽  
Mortality Rate ◽  
Geriatric Patients ◽  
Poor Health ◽  
Poor Health Status ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
One Year ◽  
Glucose Lowering Therapy

Abstract Background Glucose-lowering therapy (GLT) should be individualized in older patients with type 2 diabetes (T2D) according to their health status and their life expectancy. This study aimed at assessing the inappropriateness of GLT prescribing and the one-year mortality rate in geriatric patients with T2D. Methods Retrospective cohort study of consecutive inpatients with T2D admitted to a geriatric ward of a Belgian university hospital. Inclusion criteria were age ≥ 75 years, T2D with GLT before admission, and HbA1c measurement during the hospital stay. Comorbidities and geriatric syndromes were collected. GLT agents were classified into hypoglycaemic and non-hypoglycaemic ones, and their dosages were expressed in daily defined dose (DDD). Health status (intermediate or poor) and GLT appropriateness (appropriate, overtreatment, undertreatment) were assessed according to the 2019 Endocrine Society guideline on diabetes treatment in older adults, in which GLT overtreatment requires the presence of hypoglycaemic therapy. One-year mortality was determined using the National Registry of vital status, and its associated factors were analysed using multivariable Cox’ regression. Results The 318 geriatric patients with T2D (median age 84 years; 46% female) were in intermediate (33%) or poor health (67%). These two groups reached similar low HbA1c values (median 6.9%) with similar GLT regimens. GLT overtreatment was frequent (57%) irrespectively of the geriatric features. One-year mortality rate was high (38.5%) and associated in multivariate analysis with poor health status (HR: 1.59, p = 0.033), malnutrition (HR: 1.67, p = 0.006) and GLT overtreatment (HR: 1.73, p = 0.023). Patients with GLT overtreatment had a higher mortality rate (44.5%). Conclusions GLT overtreatment was present in more than half of these geriatric patients. Many of them were in poor health status and died within one-year. Special attention should be paid to individualisation of the HbA1c goals in the geriatric patients with diabetes, and to GLT de-intensification in those being over-treated.

scholarly journals Frailty Indexed Classification of Bangladeshi Older Adults’ Physio-psychosocial Health and Associated Risk Factors- A Cross-sectional Survey Study

2021 ◽  
Author(s):  
Mohammad Meshbahur Rahman ◽  
Mohammad Hamiduzzaman ◽  
Saleha Akter ◽  
Zaki Farhana ◽  
Mohammad Kamal Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Health Status ◽  
Family Income ◽  
Psychosocial Health ◽  
Poor Health ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Study Results ◽  
Associated Risk Factors

Abstract Background: Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults’ physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors. Methods: A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant’s health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted.Results: The participants’ mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95 % CI: 2.26–7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR=1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p<0.011) of frailty (poor health).Conclusion: Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

Abstract P050: Natural History Of Prediabetes In Middle-aged Adults

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Amelia S Wallace ◽  
Mary R Rooney ◽  
Justin Echouffo Tcheugui ◽  
Morgan Grams ◽  
Elizabeth Selvin
Keyword(s):  
Natural History ◽  
Cumulative Incidence ◽  
Multinomial Logistic Regression ◽  
Cohort Analysis ◽  
Medication Use ◽  
Single Sample ◽  
Diabetes Diagnosis ◽  
Atherosclerosis Risk In Communities ◽  
History Of ◽  
Age Range

Background: Few studies have examined the natural history of prediabetes, specifically, regression to normoglycemia as well as progression to clinical diabetes. Furthermore, there are several definitions of prediabetes in current use. Methods: We conducted a prospective cohort analysis of 8214 participants without diabetes who attended visit 2 (1990-1992) and visit 4 (1996-1998) of the Atherosclerosis Risk in Communities (ARIC) Study. We used multinomial logistic regression to compare cumulative incidence of diabetes and regression to normoglycemia among persons meeting different definitions of prediabetes (American Diabetes Association criteria): fasting glucose (FG) 100-125 mg/dL; A1C 5.7-6.4%; or elevations in both tests (single-sample confirmatory). Incident diabetes was defined as a self-reported diagnosis, medication use, or both FG ≥ 126 mg/dL and A1C ≥ 6.5%; normoglycemia was defined as both FG < 100mg/dL and A1C < 5.7% and no diabetes diagnosis or medication use. Analyses were adjusted for age, sex, and race-center. Results: The prevalence of prediabetes at visit 2 (age range, 46-69; 57% female; 17% black) was 37.6% (n=3089) based on FG criteria, 17.4% (n=1427) based on A1C criteria, and 10.6% (N=867) by both FG and A1C criteria. The 6-year cumulative incidence of diabetes was 7.2% in participants with FG-defined prediabetes, 17.1% in participants with A1C-defined prediabetes, and 22.4% in participants meeting both criteria. Among participants with prediabetes by FG criteria, regression to normoglycemia was 1.9 times as likely as progression to diabetes (14.0% vs. 7.2%). However, when prediabetes was defined by A1C and by confirmatory criteria, progression to diabetes was 1.5 times and 3.5 times more likely than regression to normoglycemia, respectively. Conclusions: Risks of progression to diabetes and regression to normoglycemia differed by prediabetes definition. Prediabetes identified by A1C criteria and single-sample confirmatory criteria identified people at highest risk for diabetes.

scholarly journals Frailty indexed classification of Bangladeshi older adults’ physio-psychosocial health and associated risk factors- a cross-sectional survey study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Meshbahur Rahman ◽  
Mohammad Hamiduzzaman ◽  
Mst. Saleha Akter ◽  
Zaki Farhana ◽  
Mohammad Kamal Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Health Status ◽  
Family Income ◽  
Psychosocial Health ◽  
Poor Health ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Study Results ◽  
Associated Risk Factors

Abstract Background Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults’ physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors. Methods A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant’s health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted. Results The participants’ mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95% CI: 2.26–7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55–59 years). Female participants were more vulnerable (adjusted OR = 1.487, 95% CI: 0.84–2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11–0.76, p < 0.011) of frailty (poor health). Conclusion Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

scholarly journals Hospitalization and Successful Aging of Community-Dwelling Older Adults: Using the Korean National Survey Data

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 137-138
Author(s):  
Ji Yeon Lee ◽  
Bora Kim ◽  
Kyung Hee Lee ◽  
Changgi Park
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Survey Data ◽  
Successful Aging ◽  
Community Dwelling ◽  
Poor Health ◽  
Poor Health Status ◽  
Community Dwelling Older Adults

Abstract Hospitalization experience can be an obstructive factor to successful aging. Although older adults who had hospitalization experience has been considered to have poor health status and low participation in one’s life, it is not obviously evident whether hospitalization itself affects successful aging. This study aimed to investigate whether three components of successful aging (i.e., diseases and disease-related complications, physical and mental functions, and engagement with life) were different in community-dwelling older adults who had hospitalization experience for the past one year compared to the counterpart older adults without hospitalization experience. A secondary data analysis was performed using a nationally representative survey data in Korea. A total of 1,812 who had hospitalization experience were matched to 1,812 control counterpart using propensity score matching. Sampling weight of the survey was considered for all statistical analysis. The community-dwelling older adults with hospitalization experience were less likely to be aging successfully than the older adults without hospitalization experience. The older adults with hospitalization experience had more chronic illnesses and malnourishment; they had more impairment in physical function and depressive symptoms; they were less active in working, social activities, and traveling. However, there were no differences in cognitive function and religious activities between the groups. In conclusion, the community-dwelling older adults who had hospitalization experience have poor health status and less engagement in one’s life in general after matching covariates using propensity score matching analysis. Therefore, more attention and assist are needed to the community-dwelling older adults with hospitalization experience to facilitate successful aging.

scholarly journals Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

2020 ◽  
Author(s):  
Alexandra K. Lee ◽  
Stephen P. Juraschek ◽  
B. Gwen Windham ◽  
Clare J. Lee ◽  
A. Richey Sharrett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cohort Analysis ◽  
Severe Hypoglycemia ◽  
Emergency Department Visits ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Risk Of Falls ◽  
Aric Study

<b>Background</b>: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div><p><b>Methods</b>: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. </p> <p><b>Results</b>: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. </p> <p><b>Conclusions</b>: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes.</p> </div> <br>

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