血红蛋白A1c时间范围,死亡率和糖尿病并发症在患有糖尿病的老年人
Paul R Conlin1,2, Julia C Prentice3,4, David C Mohr5
1VA Boston Healthcare System, West Roxbury, Massachusetts, USA paul.conlin@va.gov.
BMJ open diabetes research & care
|November 5, 2025
概括
在目标范围内保持稳定的血红蛋白A1c (A1c) 水平对于糖尿病的老年人至关重要. 更大的A1c时间范围 (A1c TIR) 与降低死亡率和减少糖尿病并发症有关.
科学领域:
- 老年学是一门学科.
- 内分泌学 在内分泌学.
- 临床医学 临床医学
背景情况:
- 老年人血红蛋白A1c (A1c) 的治疗目标通常会影响预期寿命和并发症.
- A1c稳定性也可以预测主要不良健康结果的风险.
- 这项研究研究了个性化A1c时间范围 (A1c TIR) 与老年人死亡率和糖尿病并发症之间的关联.
研究的目的:
- 检查A1c时间范围 (A1c TIR) 与糖尿病老年人主要不良结果之间的关系.
- 评估A1c稳定对老年人群死亡率和糖尿病相关并发症的影响.
主要方法:
- 一项追溯观察队列研究,涉及65岁及以上糖尿病患者,来自退伍军人事务部 (VA) 和凯泽永久 (KP) 数据库 (2004-2018).
- A1c时间范围 (A1c TIR) 是以患者特定目标范围内的A1c水平为数天的百分比计算,基于3年基线期间至少4次A1c测试.
- 估计与死亡率,心血管和微血管结局的关联使用时间到事件和仪器变量 (IV) 模型.
主要成果:
- 该研究包括386,287名VA患者和24,885名KP患者,平均年龄分别为74.3岁和72.3岁.
- 在VA和KP队列中,较低的A1c TIR (0%至<20%) 与较高的A1c TIR (80-100%) 相比,与增加的死亡率和心血管结局显著相关.
- 较长时间保持A1c水平低于或高于目标范围,与这两组患者的死亡率增加有关.
结论:
- A1c稳定性,定义为维持患者特定目标范围内的水平,与糖尿病老年人的重大不良结果风险降低有关.
- 确保A1c TIR是管理老年人糖尿病的潜在重要因素,以减轻死亡和并发症的风险.
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