Takuya Omura1, Yoshiaki Tamura1, Takashi Sakurai2, Hiroyuki Umegaki3, Satoshi Iimuro4, Yasuo Ohashi5, Hideki Ito1, Atsushi Araki1. 1. Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. 2. The Center for Comprehensive Care and Research on Demented Disorders, National Center for Geriatrics and Gerontology, Obu, Japan. 3. Department of Geriatrics and Community Healthcare, Graduate School of Medicine, University of Nagoya, Nagoya, Japan. 4. Innovation and Research Support Center, International University of Health and Welfare, Tokyo, Japan. 5. Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan.
Abstract
AIM: Although the glycemic target in older diabetes patients is based on cognition, activities of daily living and multimorbidity in the Japanese guideline, evidence of the relationships is limited. Thus, we aimed to assess the relationship between functional category and mortality in older people with diabetes. METHODS: We evaluated the data of 843 older diabetes patients in a 6-year prospective study, and the association between functional categories and all-cause mortality. The patients were divided into three functional categories based on cognition, instrumental activities of daily living and basic activities of daily living using the Mini-Mental State Examination, Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index at baseline, respectively (model 1). Those with multimorbidity (≥4 of 8 morbidities) were classified into category III (model 2). The functional category assessed using eight items from the Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index was also constructed (model 3). Hazard ratios and 95% confidence intervals were calculated in the Cox regression analysis using age, sex, body mass index, glycated hemoglobin level, total cholesterol level, estimated glomerular filtration rate and frequency of severe hypoglycemia as covariates. RESULTS: During the 6-year follow up, 64 incident mortalities occurred. The hazard ratios for mortality in categories II and III (as the reference of category I) were 1.83 (95% confidence interval 1.06-3.14, P = 0.030) and 3.05 (95% confidence interval 1.12-8.26, P = 0.029) after adjustment for covariates, respectively (model 1). Models 2 and 3 showed similar associations between functional category and mortality. CONCLUSIONS: The functional categories predicted all-cause mortality in older adults with diabetes. Geriatr Gerontol Int 2021; ••: ••-••.
AIM: Although the glycemic target in older diabetespatients is based on cognition, activities of daily living and multimorbidity in the Japanese guideline, evidence of the relationships is limited. Thus, we aimed to assess the relationship between functional category and mortality in older people with diabetes. METHODS: We evaluated the data of 843 older diabetespatients in a 6-year prospective study, and the association between functional categories and all-cause mortality. The patients were divided into three functional categories based on cognition, instrumental activities of daily living and basic activities of daily living using the Mini-Mental State Examination, Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index at baseline, respectively (model 1). Those with multimorbidity (≥4 of 8 morbidities) were classified into category III (model 2). The functional category assessed using eight items from the Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index was also constructed (model 3). Hazard ratios and 95% confidence intervals were calculated in the Cox regression analysis using age, sex, body mass index, glycated hemoglobin level, total cholesterol level, estimated glomerular filtration rate and frequency of severe hypoglycemia as covariates. RESULTS: During the 6-year follow up, 64 incident mortalities occurred. The hazard ratios for mortality in categories II and III (as the reference of category I) were 1.83 (95% confidence interval 1.06-3.14, P = 0.030) and 3.05 (95% confidence interval 1.12-8.26, P = 0.029) after adjustment for covariates, respectively (model 1). Models 2 and 3 showed similar associations between functional category and mortality. CONCLUSIONS: The functional categories predicted all-cause mortality in older adults with diabetes. Geriatr Gerontol Int 2021; ••: ••-••.