Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and...

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Autores principales:	Simone Paterni, Chukwuma Okoye, Alessia M. Calabrese, Filippo Niccolai, Antonio Polini, Nadia Caraccio, Valeria Calsolaro, Fabio Monzani
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	T2DM older patient glycated hemoglobin hip fracture HbA1c frailty Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/cdad3f012dad4de0b2bfb82f7d605e4b
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spelling	oai:doaj.org-article:cdad3f012dad4de0b2bfb82f7d605e4b2021-11-18T07:31:41ZPrognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture1664-239210.3389/fendo.2021.770400https://doaj.org/article/cdad3f012dad4de0b2bfb82f7d605e4b2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.770400/fullhttps://doaj.org/toc/1664-2392BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.Simone PaterniChukwuma OkoyeAlessia M. CalabreseFilippo NiccolaiAntonio PoliniNadia CaraccioValeria CalsolaroFabio MonzaniFrontiers Media S.A.articleT2DMolder patientglycated hemoglobinhip fractureHbA1cfrailtyDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	T2DM older patient glycated hemoglobin hip fracture HbA1c frailty Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	T2DM older patient glycated hemoglobin hip fracture HbA1c frailty Diseases of the endocrine glands. Clinical endocrinology RC648-665 Simone Paterni Chukwuma Okoye Alessia M. Calabrese Filippo Niccolai Antonio Polini Nadia Caraccio Valeria Calsolaro Fabio Monzani Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
description	BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.
format	article
author	Simone Paterni Chukwuma Okoye Alessia M. Calabrese Filippo Niccolai Antonio Polini Nadia Caraccio Valeria Calsolaro Fabio Monzani
author_facet	Simone Paterni Chukwuma Okoye Alessia M. Calabrese Filippo Niccolai Antonio Polini Nadia Caraccio Valeria Calsolaro Fabio Monzani
author_sort	Simone Paterni
title	Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
title_short	Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
title_full	Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
title_fullStr	Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
title_full_unstemmed	Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture
title_sort	prognostic value of glycated hemoglobin in frail older diabetic patients with hip fracture
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/cdad3f012dad4de0b2bfb82f7d605e4b
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Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

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