Type 2 diabetes progression ‘minimal’ when diagnosed in older adults
medwireNews: Glycated hemoglobin (HbA1c) levels deteriorate only slowly in most type 2 diabetes patients who are newly diagnosed when aged 70 years or older, say researchers.
“Our findings of minimal glycaemic deterioration in this elderly-onset group has important implications for stratifying diabetes care, suggesting that less intensive glycaemic monitoring and management is required for this group,” Ewan Pearson (University of Dundee, UK) and colleagues write in Diabetologia.
The team found that, after excluding patients with glutamic acid decarboxylase antibody (GADA) positivity and accounting for changes in variables including BMI and use of non-insulin antidiabetes drugs over time, HbA1c deteriorated by less than 1.1 mmol/mol (0.1%) per year in 66% of patients who were diagnosed when aged 70 years or older. A much smaller 24% of patients diagnosed when younger than 50 years had glycemic deterioration at this slow rate.
And just 1.5% of the elderly group deteriorated at a rate greater than 4.4 mmol/mol (0.4%) per year, compared with 15.0% of the younger group.
Overall, HbA1c in the younger group deteriorated by an average 1.67 mmol/mol (0.15%) per year more than in the older group, with intermediate rates observed in patients diagnosed between the ages of 50 and 69 years.
This age difference is “striking,” say the researchers, “and highlights how glycaemic monitoring and management in those diagnosed at over 70 years may not need to be as aggressive” as in younger patients.
HbA1c also deteriorated significantly faster in patients with lower levels of high-density lipoprotein cholesterol and higher BMIs, which the researchers say is “in keeping with the insulin resistance phenotype.”
The study cohort comprised 5491 people identified in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS) database. They were aged an average of 61.5 years and were followed up for a median of 9.4 years after diagnosis.
In addition to age, GADA positivity had a major impact on glycemic deterioration after diagnosis; people who were positive had an average annual HbA1c deterioration rate of 2.8 mmol/mol (0.25%), compared with 1.4 mmol/mol (0.12%) among those who were negative.
In keeping with this, 45.0% of patients with GADA positivity had progressed to insulin use by the end of follow-up, compared with 20.2% of those who were negative.
“[W]e know from the UKPDS that GADA positivity is a strong predictor of diabetes progression, and here we have shown that GADA-positive individuals progress approximately two times faster than individuals with type 2 diabetes,” say the researchers.
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