1356-P: Association of HbA1c with Diabetes Outcomes across Health Status Categories in Older Adults

Abstract

For older adults with type 2 diabetes (T2D) on insulin/sulfonylureas, Endocrine Society recommends HbA1c between 7-<7.5% for those in good health, 7.5-<8% for those in intermediate health, and 8-<8.5% for those in poor health. We evaluated associations between HbA1c levels and complications in adults age ≥65 yrs with T2D on insulin/sulfonylureas from an integrated healthcare delivery system. Complications included any microvascular or macrovascular events, severe hypoglycemia, or mortality during calendar year 2019. We categorized HbA1c (last result prior to 1/1/2019) as being below (overtreated), within (reference), or above (undertreated) recommended target range. Health status was adapted from the ADA Standards of Care. Cox proportional hazards models of complications were adjusted for sociodemographic and clinical variables. Among 63429 eligible patients (mean age 74.2 yrs, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health who were overtreated or undertreated (Table). Among those with intermediate health, complication risk was elevated only for those who were undertreated. Among those with poor health, complication risk did not differ significantly by level of attained HbA1c. Factors other than HbA1c level are likely to be more important predictors and/or drivers of complications in patients with T2D and poor health. Disclosure K.J.Lipska: Other Relationship; UpToDate. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. J.Liu: None. M.M.Parker: Research Support; Dexcom, Inc. H.H.Moffet: Research Support; Dexcom, Inc. R.W.Grant: None. N.Laiteerapong: None. A.J.Karter: None. Funding National Institute on Aging (R01AG063391, R56AG074986); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924, P30DK092949)