Introduction: In older adults with diabetes, the potential risks of tight glycemic control are a major concern. The 2020 American Diabetes Association (ADA) guidelines suggest different A1C targets in older adults based on comorbid health status. However, the association of A1C levels with mortality by ADA health status categories is uncharacterized.

Methods: We conducted a prospective analysis of 2068 older participants (mean age 76±5; 57% women, 30% black) with diabetes in the ARIC Study (baseline, 2011-13). We categorized health status based on ADA criteria (see Table) and evaluated mortality risk overall and by A1C categories.

Results: In older adults with diabetes, 45% were classified as healthy, 39% were complex/intermediate, and 15% had very complex/poor health. Over 6 years of follow-up, those with complex/intermediate or very complex/poor health had higher mortality risk than those classified as healthy (Table). Regardless of health status, older adults with A1C <7% were not at significantly higher risk of mortality than those with A1C 7-<8%.

Conclusions: There were substantial differences in mortality based on the ADA health status categories but, within categories, those meeting more stringent A1C goals (<7%) were not at substantially elevated risk. Our results suggest that certain patients may safely achieve lower A1C goals even in older age.


M.R. Rooney: None. O. Tang: None. B. Windham: None. J.B. Echouffo Tcheugui: None. P. Lutsey: None. M. Grams: Other Relationship; Self; DCI. E. Selvin: None.


National Heart, Lung, and Blood Institute (T32HL007024)

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