Association between glycemic control and cardiovascular events in older Japanese adults with diabetes mellitus: An analysis of the Japanese medical administrative database

Abstract

Aims/Introduction The relationship between glycated hemoglobin (HbA1c) and cardiovascular events in older adults was investigated using a Japanese administrative medical database. Materials and Methods Anonymized medical data on patients with diabetes mellitus aged ≥65 years for the period from January 2010 to December 2019 were extracted from the EBM Provider database. The primary end‐point was a composite of cardiovascular events, whereas the other end‐points included severe hypoglycemia and fracture. The association between cardiovascular events and HbA1c at the index date (i.e., approximately 10 months after initial diabetes mellitus diagnosis) was evaluated using the Cox proportional hazards model. Results Among the 3,186,751 patients in the database, 3,946 older adults with diabetes mellitus were eligible for inclusion and were subsequently grouped according to HbA1c quartiles at the index date. Cardiovascular events occurred in 142 patients. Patients with HbA1c in the highest quartile had significantly higher risk of hospitalization for cardiovascular disease than those with HbA1c in the lowest quartile (hazard ratio 1.948; 95% confidence interval 1.252–3.031, P = 0.003). However, the events risk was similar across subgroups with HbA1c <7.2%. The incidence of hypoglycemia and fracture was not significantly associated with the level of glycemic control. Conclusions Among older adults with diabetes mellitus, those with poor glycemic control were at higher risk for cardiovascular events compared with those with better glycemic control. However, strict glycemic control had no effect on cardiovascular risk in patients with HbA1c <7.2%.

Current status of low‐density lipoprotein cholesterol for primary prevention of coronary artery disease in late‐stage elderly persons with type 2 diabetes mellitus: A retrospective, single‐center study

“…Because the database contained data collected from approximately 20% of all large hospitals across Japan, the study would represent the general glycemic status in Japanese elderly persons with diabetes. HbA1c in the present study was 7.0%, which was similar to, but slightly higher than in that study 39 . Interestingly, SGLT2 inhibitors were more prescribed in the patients receiving LDL‐C‐lowering therapy than in patients not receiving it.…”

“…The number of older adults with diabetes has been increasing in proportion to the overall aging of the Japanese population. A study based on the Japanese medical administrative database for the period from January 2010 to December 2019 reported that the mean HbA1c was 6.82% in 3,946 patients with type 2 diabetes mellitus aged ≥65 years under continuous physician‐supervised treatment 39 . Because the database contained data collected from approximately 20% of all large hospitals across Japan, the study would represent the general glycemic status in Japanese elderly persons with diabetes.…”

Efficacy and safety of sitagliptin treatment in older adults with moderately controlled type 2 diabetes: the STREAM study

“…However, a J-shaped relationship was observed between stroke incidence and HbA1c in the J-EDIT study, where an HbA1c level of 7.3–7.9% was correlated with the lowest risk 10 . Furthermore, a recent analysis of a Japanese administrative medical database revealed that older diabetic patients with poor glycemic control were at a higher risk of cardiovascular events, but patients with HbA1c levels < 7.2% showed no further risk reduction by decreasing HbA1c 11 . Therefore, tight glycemic control should be avoided to prevent macrovascular complications in older adults with diabetes.…”

Validation study of case-identifying algorithms for severe hypoglycemia using hospital administrative data in Japan

“…Although there are several causes of hypoglycemia, the majority of cases among patients with diabetes arise from use of glucose-lowering therapies, particularly insulins and sulfonylureas [2,3]. Severe hypoglycemia is a serious complication of diabetic therapy, associated with increased risk of mortality and morbidity [4][5][6][7][8] and significant socioeconomic costs, including the frequent requirement for emergency department visits and hospitalization [9].…”