Mortality Implications of Prediabetes and Diabetes in Older Adults.

Abstract

OBJECTIVE:

Diabetes in older age is heterogeneous, and the treatment approach varies by patient characteristics. We characterized the short-term all-cause and cardiovascular mortality risk associated with hyperglycemia in older age.

RESEARCH DESIGN AND METHODS:

We included 5,791 older adults in the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013; ages 66-90 years). We compared prediabetes (HbA1c 5.7% to <6.5%), newly diagnosed diabetes (HbA1c ≥6.5%, prior diagnosis <1 year, or taking antihyperglycemic medications <1 year), short-duration diabetes (duration ≥1 year but <10 years [median]), and long-standing diabetes (duration ≥10 years). Outcomes were all-cause and cardiovascular mortality (median follow-up of 5.6 years).

RESULTS:

Participants were 58% female, and 24% had prevalent cardiovascular disease. All-cause mortality rates, per 1,000 person-years, were 21.2 (95% CI 18.7, 24.1) among those without diabetes, 23.7 (95% CI 20.8, 27.1) for those with prediabetes, 33.8 (95% CI 25.2, 45.5) among those with recently diagnosed diabetes, 29.6 (95% CI 25.0, 35.1) for those with diabetes of short duration, and 48.6 (95% CI 42.4, 55.7) for those with long-standing diabetes. Cardiovascular mortality rates, per 1,000 person-years, were 5.8 (95% CI 4.6, 7.4) among those without diabetes, 6.6 (95% CI 5.2, 8.5) for those with prediabetes, 11.5 (95% CI 7.0, 19.1) among those with recently diagnosed diabetes, 8.2 (95% CI 5.9, 11.3) for those with diabetes of short duration, and 17.3 (95% CI 13.8, 21.7) for those with long-standing diabetes. After adjustment for other cardiovascular risk factors, prediabetes and newly diagnosed diabetes were not significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.03 [95% CI 0.85, 1.23] and HR 1.31 [95% CI 0.94, 1.82], respectively) or cardiovascular mortality (HR 1.00 [95% CI 0.70, 1.43] and HR 1.35 [95% CI 0.74, 2.49], respectively). Excess mortality risk was primarily concentrated among those with long-standing diabetes (all-cause: HR 1.71 [95% CI 1.40, 2.10]; cardiovascular: HR 1.72 [95% CI 1.18, 2.51]).

CONCLUSIONS:

In older adults, long-standing diabetes has a substantial and independent effect on short-term mortality. Older individuals with prediabetes remained at low mortality risk over a median 5.6 years of follow-up.

• Authors: Olive Tang, Kunihiro Matsushita, Josef Coresh, A Richey Sharrett, John W McEvoy, B Gwen Windham, Christie M Ballantyne, Elizabeth Selvin
• Journal: Diabetes care (Diabetes Care) Vol. 43 Issue 2 Pg. 382-388 (02 2020) ISSN: 1935-5548 [Electronic] United States
• PMID: 31776141 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2019 by the American Diabetes Association.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Atherosclerosis (epidemiology, etiology, mortality)
• Cardiovascular Diseases (epidemiology, etiology, mortality)
• Cause of Death
• Diabetes Mellitus (diagnosis, epidemiology, mortality)
• Diabetic Angiopathies (epidemiology, etiology, mortality)
• Female
• Humans
• Hyperglycemia (complications, epidemiology, mortality)
• Male
• Prediabetic State (complications, diagnosis, epidemiology, mortality)
• Prevalence
• Prognosis
• Risk Factors
• Time Factors