OBJECTIVE To determine the impact of type 2 diabetes and glycated hemoglobin (HbA1c) levels within the recommended target range according to the Japan Diabetes Society/Japan Geriatrics Society Joint Committee on mortality in older adults with cognitive impairment. RESEARCH DESIGN AND METHODS This retrospective cohort study included 1,528 and 468 patients aged ≥65 years without and with type 2 diabetes, respectively, who were visiting a memory clinic. The 468 patients with type 2 diabetes were divided into three groups (within, above, and below the target range) based on their HbA1c levels, cognitive function, ability to perform activities of daily living, and medications associated with a high risk of hypoglycemia. The impact of diabetes and HbA1c levels on mortality was evaluated using Cox proportional hazards models. RESULTS Over a median follow-up period of 3.8 years, 353 patients (17.7%) died. Compared with individuals without type 2 diabetes, HbA1c levels above (hazard ratio [HR] 1.70, 95% CI 1.08–2.69) and below (HR 2.15, 95% CI 1.33–3.48) the target range were associated with a higher risk of death; however, HbA1c levels within the target range were not (HR 1.02, 95% CI 0.77–1.36). CONCLUSIONS HbA1c levels above and below the target range were associated with a higher risk of mortality, whereas patients with HbA1c levels within the target range did not exhibit a higher risk of mortality than individuals without type 2 diabetes. These results provide empirical support for the current target ranges among older adults with cognitive impairment.

中文翻译：

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2 型糖尿病和糖化血红蛋白水平在推荐目标范围内对在记忆诊所接受护理的认知障碍老年人死亡率的影响：NCGG-STORIES

目的 确定 2 型糖尿病和糖化血红蛋白 (HbA1c) 水平在日本糖尿病学会/日本老年医学会联合委员会建议的目标范围内对认知障碍老年人死亡率的影响。研究设计和方法 这项回顾性队列研究包括 1,528 名和 468 名年龄≥65 岁、未患有 2 型糖尿病和患有 2 型糖尿病的患者，他们正在记忆诊所就诊。根据 HbA1c 水平、认知功能、日常生活活动能力以及与低血糖高风险相关的药物情况，468 名 2 型糖尿病患者被分为三组（在目标范围内、高于和低于目标范围）。使用 Cox 比例风险模型评估糖尿病和 HbA1c 水平对死亡率的影响。结果 在 3.8 年的中位随访期内，353 名患者 (17.7%) 死亡。与没有 2 型糖尿病的个体相比，HbA1c 水平高于目标范围（风险比 [HR] 1.70，95% CI 1.08–2.69）和低于目标范围（HR 2.15，95% CI 1.33–3.48）与较高的死亡风险相关; 然而，HbA1c 水平并未达到目标范围（HR 1.02，95% CI 0.77–1.36）。结论 HbA1c 水平高于和低于目标范围均与较高的死亡风险相关，而 HbA1c 水平在目标范围内的患者并未表现出比非 2 型糖尿病患者更高的死亡风险。这些结果为患有认知障碍的老年人当前的目标范围提供了实证支持。