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. 2021 Nov 18:12:770400.
doi: 10.3389/fendo.2021.770400. eCollection 2021.

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

Simone Paterni  1 , Chukwuma Okoye  1 , Alessia M Calabrese  1 , Filippo Niccolai  1 , Antonio Polini  1 , Nadia Caraccio  1 , Valeria Calsolaro  1 , Fabio Monzani  1
Affiliations

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

Simone Paterni et al. Front Endocrinol (Lausanne). .

Abstract

Background: Previous 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.

Aim: To investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.

Methods: Prospective 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.

Results: Among 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.

Conclusions: Frail 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.

Keywords: HbA1c; T2DM; frailty; glycated hemoglobin; hip fracture; older patient.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Mortality rate of diabetic patients stratified by frailty degree (frail: CFS ≥ 5; robust: CFS < 5) according to HbA1c tertiles.
See this image and copyright information in PMC

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