Glycaemic markers and all-cause mortality in older adults with and without diabetes: the Atherosclerosis Risk in Communities (ARIC) study.

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 (

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.