Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
Diabetologia. 2021 Feb;64(2):339-348. doi: 10.1007/s00125-020-05285-3. Epub 2020 Sep 29.
AIMS/HYPOTHESIS: There is controversy regarding the performance of HbA in old age. We evaluated the prognostic value of HbA and other glycaemic markers (fructosamine, glycated albumin, fasting glucose) with mortality risk in older adults (66-90 years). METHODS: This was a prospective analysis of 5636 participants (31% with diagnosed diabetes, mean age 76, 58% female, 21% black) in the Atherosclerosis Risk in Communities (ARIC) study, baseline 2011-2013. We used Cox regression to examine associations of glycaemic markers (modelled in categories) with mortality risk, stratified by diagnosed diabetes status. RESULTS: During a median of 6 years of follow-up, 983 deaths occurred. Among older adults with diabetes, 30% had low HbA (<42 mmol/mol [<6.0%]) and 10% had high HbA (≥64 mmol/mol [≥8.0%]); low (HR 1.32 [95% CI 1.04, 1.68]) and high (HR 1.86 [95% CI 1.32, 2.62]) HbA were associated with mortality risk vs HbA 42-52 mmol/mol (6.0-6.9%) after demographic adjustment. Low fructosamine and glycated albumin were not associated with mortality risk. Both low and high fasting glucose were associated with mortality risk. After further adjustment for lifestyle and clinical risk factors, high HbA (HR 1.81 [95% CI 1.28, 2.56]), fructosamine (HR 1.96 [95% CI 1.43-2.69]), glycated albumin (HR 1.81 [95% CI 1.33-2.47]) and fasting glucose (HR 1.81 [95% CI 1.24, 2.66]) were associated with mortality risk. Low HbA and fasting glucose were no longer significantly associated with mortality risk. Among participants without diabetes, associations of glycaemic markers with mortality risk were less robust. CONCLUSIONS/INTERPRETATION: Elevated HbA, fructosamine, glycated albumin and fasting glucose were associated with risk of mortality in older adults with diabetes. Low HbA and fasting glucose may be markers of poor prognosis but are possibly confounded by health status. Our findings support the clinical use of HbA in older adults with diabetes. Graphical abstract.
目的/假设：关于老年人 HbA 的表现存在争议。我们评估了 HbA 和其他血糖标志物（果糖胺、糖化白蛋白、空腹血糖）与老年（66-90 岁）成年人死亡率风险的相关性。 方法：这是对动脉粥样硬化风险社区（ARIC）研究中 5636 名参与者（31%患有糖尿病，平均年龄 76 岁，58%为女性，21%为黑人）的前瞻性分析，基线时间为 2011-2013 年。我们使用 Cox 回归分析来检查血糖标志物（按类别建模）与死亡率风险的相关性，按诊断糖尿病的情况进行分层。 结果：在中位 6 年的随访期间，有 983 人死亡。在患有糖尿病的老年人中，30%的人 HbA 较低（<42mmol/mol [<6.0%]），10%的人 HbA 较高（≥64mmol/mol [≥8.0%]）；与 HbA 42-52mmol/mol（6.0-6.9%）相比，低（HR 1.32 [95%CI 1.04, 1.68]）和高（HR 1.86 [95%CI 1.32, 2.62]）HbA 与死亡率风险相关，在调整人口统计学因素后。果糖胺和糖化白蛋白与死亡率风险无关。低和高空腹血糖均与死亡率风险相关。进一步调整生活方式和临床危险因素后，高 HbA（HR 1.81 [95%CI 1.28, 2.56]）、果糖胺（HR 1.96 [95%CI 1.43-2.69]）、糖化白蛋白（HR 1.81 [95%CI 1.33-2.47]）和空腹血糖（HR 1.81 [95%CI 1.24, 2.66]）与死亡率风险相关。低 HbA 和空腹血糖与死亡率风险不再显著相关。在没有糖尿病的参与者中，血糖标志物与死亡率风险的相关性较弱。 结论/解释：在患有糖尿病的老年人中，HbA、果糖胺、糖化白蛋白和空腹血糖升高与死亡风险相关。低 HbA 和空腹血糖可能是预后不良的标志物，但可能与健康状况有关。我们的研究结果支持在患有糖尿病的老年人群中使用 HbA。
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