Zaslavsky Oleg, Walker Rod L, Crane Paul K, Gray Shelly L, Larson Eric B
Department of Biobehavioral Nursing and Health Informatics University of Washington Seattle USA.
Kaiser Permanente Washington Health Research Institute Seattle USA.
Alzheimers Dement (N Y). 2020 Aug 13;6(1):e12058. doi: 10.1002/trc2.12058. eCollection 2020.
We modeled associations between glycated hemoglobin (HbA1c) levels (<7%, 7% to 8%, and >8%) and cognitive and physical function among adults 80+ years of age with diabetes and determined whether associations differ by frailty, multimorbidity, and disability.
A total of 316, adults with diabetes, 80+ years of age, were from the Adult Changes in Thought Study. Cognitive Abilities Screening Instrument Item Response Theory (CASI-IRT) measured cognition. Short performance-based physical function (sPPF) and gait speed measured physical function. Glycosylated hemoglobin (HbA1c) levels were from clinical measurements. Analyses estimated associations between average HbA1c levels (<7%, 7% to 8%, and >8%) and functional outcomes using linear regressions estimated with generalized estimating equations.
sPPF scores did not differ significantly by HbA1c levels. Gait speed did, but only for non-frail individuals; those with HbA1c >8% were slower (-0.10 m/s [95% CI, -0.16 to -0.04]) compared to those with HbA1c 7% to 8%. The association between HbA1c and CASI-IRT varied with age (interaction = 0.04). At age 80, for example, relative to people with HbA1c levels of 7% to 8%, CASI-IRT scores were, on average, 0.18 points lower (95% CI, -0.35 to -0.02) for people with HbA1c <7% and 0.22 points lower (95% CI, -0.40 to -0.05) for people with HbA1c >8%. At older ages, these estimated differences were attenuated. Estimated associations were not modified by multimorbidity or disability.
Moderate HbA1c levels of 7% to 8% were associated with better cognition in early but not late octogenarians with diabetes. Furthermore, HbA1c >8% was associated with slower gait speed among those without frailty. These results add to an evidence base for determining glucose targets for very old adults with diabetes.
我们对80岁及以上患有糖尿病的成年人糖化血红蛋白（HbA1c）水平（<7%、7%至8%和>8%）与认知及身体功能之间的关联进行了建模，并确定这些关联是否因虚弱、多病共存和残疾情况而有所不同。
共有316名80岁及以上患有糖尿病的成年人参与了成人思维变化研究。认知能力筛查工具项目反应理论（CASI-IRT）用于测量认知。基于表现的简短身体功能（sPPF）和步速用于测量身体功能。糖化血红蛋白（HbA1c）水平来自临床测量。分析使用广义估计方程估计的线性回归，评估平均HbA1c水平（<7%、7%至8%和>8%）与功能结局之间的关联。
sPPF得分在不同HbA1c水平之间无显著差异。步速存在差异，但仅在非虚弱个体中；与HbA1c水平在7%至8%的个体相比，HbA1c>8%的个体步速较慢（-0.10 m/s [95% CI，-0.16至-0.04]）。HbA1c与CASI-IRT之间的关联随年龄而变化（交互作用=0.04）。例如，在80岁时，与HbA1c水平为7%至8%的人群相比，HbA
