HbA1c levels and all-cause mortality in type 2 diabetic patients: Epidemiological evidence of the need for personalised therapeutic targets
| Autor: | Nadia Bartoli, Matteo Monami, Valentina Vitale, Daniele Martelli, Edoardo Mannucci, Niccolò Marchionni, Alessandro Antenore, S. Zannoni, Caterina Lamanna, G. Toffanello |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Frail Elderly Endocrinology Diabetes and Metabolism Medicine (miscellaneous) Comorbidity Risk Assessment Case mix index Risk Factors Diabetes mellitus Internal medicine Epidemiology medicine Humans Hypoglycemic Agents Insulin Precision Medicine Aged Aged 80 and over Glycated Hemoglobin Chi-Square Distribution Nutrition and Dietetics business.industry Age Factors Case-control study Middle Aged Prognosis medicine.disease Logistic Models Diabetes Mellitus Type 2 Italy Case-Control Studies Cohort Physical therapy Female Cardiology and Cardiovascular Medicine Risk assessment business Body mass index Biomarkers |
| Zdroj: | Nutrition, Metabolism and Cardiovascular Diseases. 23:300-306 |
| ISSN: | 0939-4753 |
| Popis: | The aim of the present case-control study is to explore the effect of case mix on the relationship between glycated haemoglobin (HbA1c) and mortality in type 2 diabetic patients.A nested case-control study data set was generated from the cohort-study data set (n = 4140 type 2 diabetic outpatients) by sampling controls from the risk sets. Cases (n = 427) were compared with an equal number of controls chosen from those members of the cohort who were at risk for the same follow-up time of the case, matched for age (±3 years), sex, body mass index (BMI) (±2 kg m(-2)), duration of diabetes (±5 years), and Charlson's Comorbidity Score (CCS) (±1). The main predefined analysis was the comparison of cases and controls for proportion of patients with each HbA1c class (6.5%, 6.5-7.4%, 7.5-8.4% and ≥8.5%). During a mean follow-up of 5.7 ± 3.5 years, 427 deaths were recorded. The lowest risk of death was observed in the HbA1c 6.5-7.4% category; a lower HbA1c was associated with a non-significant trend towards a higher risk. The risk associated with a low (6.5%) HbA1c was significantly greater in patients who were insulin-treated than in the rest of the sample.The present study suggests that glycaemic targets should be individualised on the basis of the characteristics of each patient, considering age, co-morbidity and duration of diabetes. Caution should be used in prescribing insulin to reach near-normoglycaemia, particularly in older, frail patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect