Angela M Abbatecola1, Mario Bo2, Fabio Armellini3, Ferdinando D'Amico4, Giovambattista Desideri5, Paolo Falaschi6, Antonio Greco7, Gianbattista Guerrini8, Fabrizia Lattanzio9, Clelia Volpe10, Giuseppe Paolisso11. 1. Alzheimer's Disease Clinic, ASL Frosinone, Atina, Italy. Electronic address: angela_abbatecola@yahoo.com. 2. University of Turin, Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy. 3. Division of Geriatrics, Hospital of Valdagno, Italy. 4. Azienda Sanitaria Provinciale di Messina, Messina, Italy. 5. University of Aquila, Aquila, Italy. 6. Sapienza University of Rome, Rome, Italy. 7. Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy. 8. Fondazione Brescia Solidale, Brescia, Italy. 9. Italian National Research Center on Aging (INRCA), Scientific Direction, Ancona, Italy. 10. ASL Napoli 1, Naples, Italy. 11. Second University of Naples, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Naples, Italy.
Abstract
BACKGROUND: There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. METHODS: We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. RESULTS: Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050). CONCLUSIONS: Tighter glycemic control was associated with ADL physical dependency losses, especially in those using sulfonylureas and mitiglinides.
BACKGROUND: There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. METHODS: We conducted a cross-sectional study on 1845 older NHpatients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. RESULTS:Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050). CONCLUSIONS: Tighter glycemic control was associated with ADL physical dependency losses, especially in those using sulfonylureas and mitiglinides.
Authors: Jason I Chiang; Bhautesh Dinesh Jani; Frances S Mair; Barbara I Nicholl; John Furler; David O'Neal; Alicia Jenkins; Patrick Condron; Jo-Anne Manski-Nankervis Journal: PLoS One Date: 2018-12-26 Impact factor: 3.240