Narrower glucose range optimal for elderly Asians with comorbidities
medwireNews: Narrower target glucose range than currently recommended may produce the lowest cardiovascular and mortality risk in older Asian people with type 2 diabetes, say the authors of a real-world study.
Ji Huh (Hallym University Sacred Heart Hospital, Anyang, South Korea) and co-researchers note that current ADA guidelines advise a fasting glucose target range of 90–150 mg/dL (5.0–8.3 mmol/L) for older people with diabetes and multiple comorbidities.
However, they believe that this range “might be suboptimal” for their population of older Asians with comorbidities, in whom a narrower range of 110–124 mg/dL (6.1–6.9 mmol/L) was associated with the lowest risk for mortality.
Outside of this range, there was an “abrupt increase” in the risk for both mortality and cardiovascular events, the team reports in Cardiovascular Diabetology.
The findings come from South Korean national health screening records for 227,938 people aged at least 65 years (average 72.5 years) who had type 2 diabetes but no prior cardiovascular events and had fasting glucose measured at two consecutive biennial screenings. Between the second measurement at the 2011–2012 screening and the end of 2017, a total of 27,212 people died and 17,406 had a first myocardial infarction or stroke.
There was a J-shaped association between fasting glucose and outcomes, with the optimal level – associated with the lowest risk – being 122 mg/dL (6.8 mmol/L) for mortality and 116 mg/dL (6.4 mmol/L) for cardiovascular outcomes. Comorbidity did not influence the optimal glucose level associated with mortality risk; however, the optimal level for cardiovascular risk was higher in the 61% of people with a Charlson Comorbidity Index score of at least 3 than in those with less comorbidity, at 119 versus 112 mg/dL (6.6 vs 6.2 mmol/L).
Likewise, people with a higher comorbidity burden had a significantly increased risk for cardiovascular outcomes if their fasting glucose was below 95 mg/dL (5.3 mmol/L) or above 140 mg/dL (7.8 mmol/L) relative to the optimal glucose range of 110–124 mg/dL (6.1–6.9 mmol/L), after accounting for multiple confounders, whereas risk only increased above this range for people with less comorbidity.
Mortality risk was increased on both sides of the optimal range irrespective of comorbidity burden and was again independent of variables such as age, sex, income, diabetes duration, smoking status, and blood pressure.
“These findings provide further evidence that not only too loose glucose control but also too stringent glucose control could increase the risk of adverse health outcomes in older patients with diabetes,” conclude the researchers, who highlight that theirs is the first study to address this issue in East Asians.
They add that “a more careful glycemic control is needed in fragile patients with both diabetes and multiple comorbidities to avoid hypoglycemia.”
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