Twito Orit, Ahron Ella, Jaffe Anat, Afek Shani, Cohen Efrat, Granek-Catarivas Martine, Klein Pinchas, Hermoni Doron
Corresponding author: Orit Twito,
Diabetes Care. 2013 Nov;36(11):3425-9. doi: 10.2337/dc12-2503. Epub 2013 Jul 22.
New-onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk.
The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel. Included in the study were subjects 65 years of age and above with new-onset DM. The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting.
Participants (n = 2,994) were stratified into four groups according to their mean HbA1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5-6.99% [48-52 mmol/mol], 7-7.49% [53-57 mmol/mol], and ≥7.5% [58 mmol/mol]). During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization. An HbA1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2-1.8], P < 0.0001). This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins. Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA1c 6.5-6.99% (48-52 mmol/mol) (HR 1.6 [1.01-2.4], P < 0.05) and lowest in patients with HbA1c ≥7.5% (58 mmol/mol).
An HbA1c level >7.5% (58 mmol/mol) is associated with increased risk for all-cause mortality and with a lower revascularization rate in elderly patients with new-onset DM.
老年患者新发糖尿病（DM）与糖尿病并发症及死亡率风险增加相关。该人群的血糖控制是否会影响死亡风险尚不清楚。
本研究利用以色列克拉利特医疗服务公司沙龙 - 肖姆龙地区的计算机化数据库进行。研究纳入65岁及以上的新发糖尿病患者。主要结局指标为全因死亡率以及经皮冠状动脉介入治疗或冠状动脉旁路移植术等冠状动脉血运重建手术。
参与者（n = 2994）根据随访期间的平均糖化血红蛋白（HbA1c）水平分为四组（<6.5% [48 mmol/mol]、6.5 - 6.99% [48 - 52 mmol/mol]、7 - 7.49% [53 - 57 mmol/mol]和≥7.5% [58 mmol/mol]）。在平均5.54 ± 2.1年的随访期间，1173名（39.17%）参与者死亡，285名（9.51%）接受了冠状动脉血运重建。HbA1c水平>7.5%（58 mmol/mol）与全因死亡率显著增加相关（风险比[HR] 1.74 [95% CI 1.2 - 1.8]，P < 0.0001）。在对传统心血管危险因素以及降糖药物和他汀类药物的使用进行多变量模型调整后，这种差异仍具有统计学意义。Kaplan - Meier生存曲线显示该组患者生存率较低。冠状动脉血运重建率在HbA1c为6.5 - 6.99%（48 - 52 mmol/mol）的受试者中最高（HR 1.6 [1.01 - 2.4]，P < 0.05），在HbA1c≥7.5%（58 mmol/mol）的患者中最低。
HbA1c水平>7.5%（58 mmol/mol）与新发糖尿病老年患者的全因死亡风险增加以及血运重建率降低相关。
