Abstract
BackgroundAlthough the proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM. This study assessed the determinants of glycemic control in older adults with T2DM of a duration of ≥10 years, including muscle mass, muscle quality, and β-cell function.MethodsThis was a prospective study of older patients aged ≥60 years with a T2DM duration of ≥10 years. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index, handgrip strength (HGS), and body composition through bioelectrical impedance analysis were assessed. The primary outcome was a composite of: (i) increment of glycated hemoglobin (HbA1c) from the baseline ≥0.6% and (ii) HbA1c ≥ 9% at any time point during the follow-up period. To find the predicting determinants of the outcome, we performed the Cox proportional hazard analysis.ResultsAmong 100 patients (mean age, 64.0 ± 8.6 years; median duration of diabetes, 20 [interquartile range (IQR), 17–23] years; median HbA1c at baseline, 7.1 [IQR, 6.7–7.4] %), the primary outcome was observed in 40 (40.0%) patients during 4.0 (IQR 2.3–5.0) years of follow-up. A Cox proportional hazards model adjusted for age, sex, baseline HbA1c, obesity, duration of DM and anti-diabetic medication at baseline showed that low HGS and insulin resistance at the baseline were independent determinants of the primary outcome (hazard ratio [HR] = 2.23 [95% confidence interval (CI), 1.06–4.72] and 2.39 [95% CI, 1.18–4.83], respectively). Sex stratification confirmed that HGS and muscle mass were independent determinants of the primary outcome only in women (HR per quartile, 0.58 [95% CI, 0.37–0.93] and 0.46 [95% CI, 0.25–0.85], respectively). `.ConclusionsLow HGS and insulin resistance were independent risk factors for aggravated glycemic control among older patients with long standing T2DM.
Highlights
The proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM
Patients who were at least 60 years old, diagnosed with T2DM at least 10 years ago, and had results of two consecutive oral glucose tolerance tests (OGTTs) performed 3 years apart were eligible for this study
This study identified the determinants of glycemic control in older patients with T2DM of a duration ≥10 years
Summary
The proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM. With the increasing life expectancy, the proportion of older patients with diabetes has increased [4, 5] Most of these patients have long-standing DM, which results in a high prevalence of diabetic complications and increased mortality risk [6]. Aggressive glycemic controls [7], medications [3, 7], physical activity [8], and quality of self-care are determinants of glycemic control in T2DM; few studies have reported the factors affecting glucose levels in older patients with long-standing DM. In Korea, despite the high prevalence of DM in the population ≥ 65 years old, only about 30% of them reach the target HbA1c [5]
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