Publications

The number of tuberculosis (TB) cases and global TB incidence rates is decreasing according to the latest World Health Organization Global Tuberculosis Report (1). This is very welcome news. However, the 8.8 million incident cases of TB, 1.1 million deaths from TB among HIV-negative people, the 350,000 deaths from HIV-associated TB, and the millions of children orphaned as a result of parental deaths caused by TB provide a stark reminder of the magnitude of devastation caused by TB each year. Advances in understanding TB epidemiology diagnosis and treatment in 2011, many of which were reported in the Journal, provide hope that the annual decline in TB cases will accelerate.

OBJECTIVES

To determine whether glycosylated hemoglobin (HbA1c) levels predict functional decline in older adults.

DESIGN

Longitudinal cohort study.

PARTICIPANTS

Community-dwelling, nursing home (NH)-eligible individuals with diabetes mellitus enrolled at On Lok between October 2002 and December 2008 (367 participants, 1,579 HbA1c measurements).

SETTING

On Lok Lifeways, the original model for Programs of All-Inclusive Care for the Elderly.

MEASUREMENTS

The outcomes were functional decline or death at 2 years. The primary predictor was HbA1c. Age, sex, race and ethnicity, baseline function, comorbid conditions, length of time enrolled at On Lok, insulin use, and clustering of HbA1c within participants were adjusted for with mixed-effects Poisson regression.

RESULTS

Mean age was 80, and 185 participants (50%) were taking insulin. Sixty-three percent of participants experienced functional decline, and 75% experienced death or functional decline during the study period. At 2 years, higher HbA1c was associated with less functional decline or death (P for trend = .006). Accounting for clustering and confounding factors, HbA1c of 8.0% to 8.9% was associated with a lower likelihood (relative risk = 0.88, 95% confidence interval = 0.79-0.99) of functional decline or death than HbA1c of 7.0% to 7.9%.

CONCLUSION

In community-dwelling, NH-eligible individuals with diabetes mellitus, HbA1c of 8.0% to 8.9% is associated with better functional outcomes at 2 years than HbA1c of 7.0% to 7.9%, suggesting that the current American Geriatrics Society guideline recommending a HbA1c target of 8.0% or less for older adults with limited life expectancy may be lower than necessary to maintain function.