Title | Mortality Implications of Prediabetes and Diabetes in Older Adults. |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Tang O, Matsushita K, Coresh JJ, Sharrett ARichey, McEvoy JW, B Windham G, Ballantyne CM |
Secondary Authors | Selvin E |
Journal | Diabetes Care |
Volume | 43 |
Issue | 2 |
Pagination | 382-388 |
Date Published | 2020 02 |
ISSN | 1935-5548 |
Keywords | Age Factors, Aged, Aged, 80 and over, Atherosclerosis, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Diabetic Angiopathies, Female, Humans, Hyperglycemia, Male, Prediabetic State, Prevalence, Prognosis, Risk Factors, Time Factors |
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 (HbA 5.7% to 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. |
DOI | 10.2337/dc19-1221 |
Alternate Journal | Diabetes Care |
PubMed ID | 31776141 |
PubMed Central ID | PMC6971785 |
Grant List | R01 DK089174 / DK / NIDDK NIH HHS / United States HHSN268201700002C / HL / NHLBI NIH HHS / United States HHSN268201700001I / HL / NHLBI NIH HHS / United States F30 DK120160 / DK / NIDDK NIH HHS / United States HHSN268201700004C / HL / NHLBI NIH HHS / United States R01 HL134320 / HL / NHLBI NIH HHS / United States HHSN268201700003I / HL / NHLBI NIH HHS / United States K24 DK106414 / DK / NIDDK NIH HHS / United States HHSN268201700004I / HL / NHLBI NIH HHS / United States HHSN268201700005C / HL / NHLBI NIH HHS / United States HHSN268201700001C / HL / NHLBI NIH HHS / United States HHSN268201700003C / HL / NHLBI NIH HHS / United States HHSN268201700002I / HL / NHLBI NIH HHS / United States HHSN268201700005I / HL / NHLBI NIH HHS / United States |