Characterising the phenotype of diabetes mellitus in older men: associations with poorer self-rated health, reduced healthy lifestyle behaviours, adverse cardiovascular risk and injurious falls in the setting of normal or slightly elevated HbA1c — ASN Events
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  3. Characterising the phenotype of diabetes mellitus in older men: associations with poorer self-rated health, reduced healthy lifestyle behaviours, adverse cardiovascular risk and injurious falls in the setting of normal or slightly elevated HbA1c

Characterising the phenotype of diabetes mellitus in older men: associations with poorer self-rated health, reduced healthy lifestyle behaviours, adverse cardiovascular risk and injurious falls in the setting of normal or slightly elevated HbA1c (#273)

Meg Ritchie 1 2 , Helman Alfonso 3 , Leon Flicker 2 4 , Jillian George 4 , Graeme J Hankey 2 , Osvaldo P Almeida 4 5 , Jonathan Golledge 6 7 , Paul E Norman 8 , Bu B Yeap 1 2
  1. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
  2. School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
  3. School of Public Health, Curtin University, Perth, Western Australia, Australia
  4. Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
  5. School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
  6. Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine, James Cook University, Townsville, Queensland, Australia
  7. Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
  8. Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia

Context

As the incidence of Type 2 diabetes is highest from middle to older ages, population ageing is driving an increasing prevalence of diabetes worldwide.  Despite the growing burden of diabetes in older adults, diabetes-associated morbidities and optimal means of monitoring glycaemic therapy in this population are not well defined.

Objectives

To examine demographic, physical and biochemical characteristics and medical comorbidities associated with diabetes in older men.

Methods

Cross sectional analysis of community-dwelling older men aged 79 to 97 years from a population-based cohort study in Perth, Western Australia.  Questionnaire and physical assessment data were collected, and fasting blood glucose and HbA1c assayed. 

Results

Of 1427 men, 316 had diabetes (22.1%).  Men with diabetes were of comparable age to non-diabetic men (84.9 vs 84.5 years, p=0.092), but had a higher prevalence of hypertension (48.4% vs 40.9%, p=0.017), high cholesterol (50.5% vs 38.2%, p<0.001), angina (29.0% vs 19.3%, p < 0.001), heart attack (25.3 vs 16.6%, p<0.001), heart failure (12.7 vs 4.9%, p<0.001) and stroke (17.5 vs 11.7%, p=0.007).  Only 25.6% of men with diabetes self-rated their health as excellent or very good, compared with 40.9% of non-diabetic men (p<0.001). Men with diabetes were less likely to participate in recreational walking (33.3% vs 40.9%, p=0.016) and leisure activity (19.4% vs 26.4%, p=0.011).  In multivariate analyses, diabetes was associated with an increased prevalence of myocardial infarction (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.18-7.16, p=0.02) and injurious falls (OR 4.58, 95% CI 1.76-11.92, p<0.001).  Average HbA1c was 6.63±0.83% in diabetic men vs 5.74±0.31% in non-diabetic men.  Average fasting glucose was 6.96±2.28 mmol/L vs 5.29±0.51 mmol/L respectively. Of men with diabetes, 20.9% had an HbA1c ≥7%, compared with 34.3% with fasting glucose ≥7.1mmol/L. 

Conclusions

In older men, diabetes remains associated with adverse cardiovascular risk factors and disease, and poorer self-perceived health. Diabetes in this population is associated with less healthy lifestyle behaviours and increased risk of injury from falls, potentially important areas for intervention.  With diabetes, HbA1c values are commonly <7.0%, with a greater spread of fasting glucose. Further evaluation of age-appropriate therapeutic targets for HbA1c is warranted in older adults.