HbA1c and Age in Non-Diabetic Subjects: An Ignored Association?

Abstract

Target HbA values given in the most National Therapeutic Guidelines for patients with diabetes and cut-off HbA values for diabetes diagnosis are usually not taking the age of the respective patients into account; despite the fact that an increase in HbA in subjects without diabetes with age is known for some time. In order to further quantify the association between age and HbA in non-diabetic subjects an analysis of one German register was performed. In this cross-sectional study we analyzed data from 7 699 visits of 2 921 patients without diabetes (age 46.6 y [range 18-93 y]; 69.1% women; BMI 27.6±6.4 kg/m²) who had at least one HbA and blood glucose measurement. Data were drawn from an electronic patient record system (EMIL™) in which data were collected between 01/1992 and 01/2014. The patients were divided in 6 age groups (< 30 years [n=1 057];>30-40 years [n=1 160];>40-50 years [n=1 693];>50-60 years [n=1 523];>60-70 years [n=1 310];>70 years [n=956]) and the HbA values of these groups were compared. Patients with: gestational diabetes use of systemic glucocorticoids, malignant neoplasm, age<18 y at time of first visit and IGT were excluded. HbA measurements were DCCT adjusted. Patients with age>70 years have a 0.47% [5.14 mmol/mol] higher HbA compared to those<30 years. The mean HbA of the age groups was:<30 4.98% [30.96 mmol/mol],>30-40 5.07% [31.99 mmol/mol],>40-50 5.17% [33.10 mmol/mol],>50-60 5.33% [34.79 mmol/mol],>60-70 5.42% [35.79 mmol/mol] and>70 years 5.45% [36.10 mmol/mol]. In a multiple linear model the regression coefficient for each year of age increase was β=0.0074 (p<0.001); thus age results in an increase of 0.074% in HbA per decade. HbA increases significantly with ageing in people without diabetes. The use of different cut-off values for every age range for diagnosis of diabetes should be discussed.

Association Between Glycaemic Control and the Intake of Thiazide Diuretics, Beta Blockers and Levothyroxine in People Without Diabetes

“…As expected, people who did not take any medication were significantly younger compared to the other groups, but still showed a stably slight increase in HbA 1c while ageing compared to the whole study population. Thus, the detectable HbA 1c increase in the ANOVA model may also have contributed to ageing alone [28,36]. The linear mixed model confirmed the known and previously described association of age, BMI and smoking status with HbA 1c [27][28][29]36].…”

Prevalence of type 2 diabetes and prediabetes in the Faroe Islands

“…The profile of our NGT group (see Table 2) was comparable to the low risk group in terms of BMI, abnormal WHR, and cardiac and hereditary conditions, but similar in age to the other prediabetic and diabetic groups. Age-related cut-off levels for HbA1c have been proposed to deal with this discrepancy, as HbA1c concentrations increased by 0.074% per decade in non-diabetics [27]. In addition, older subjects with T2D had better functional outcomes with HbA1c levels between 8.0% (64 mmol/mol) and 8.9% (74 mmol/mol), as compared to those between 7.0% (53 mmol/mol) and 7.9% (63 mmol/mol) [28].…”

Non‐response to fluconazole maintenance treatment (ReCiDiF regimen) for recurrent vulvovaginal candidosis is not related to impaired glucose metabolism

“…Comparing HbA1c percentages divided into percentiles (25, 50, 75), no difference among groups was observed (Kruskal‐Wallis P =.46). Also, if we divided the HBa1c values of OR and NR in different age groups and compared them to formerly published data (Table ).…”