Life Expectancy Adjusted Adherence to Glycemic Control Guideline and Long-Term Mortality Risk among U.S. Older Adults with Diabetes

Adequate glycemic control in patients with diabetes is critically important in reducing microvascular complications, cardiovascular disease, and other adverse outcomes. The objective of this study was to examine whether life expectancy adjusted adherence to glycemic control guidelines is associated with 10-year mortality risk among U.S. older adults with diabetes. The study sample was obtained by merging the 2002 Health and Retirement Study interview data, the 2003 biomarker data, and the 2012 all-cause mortality data. The sample consisted of 1,219 adults ages 50 and over who were interviewed in 2002 and had a valid hemoglobin A1c (HbA1c) measurement in 2003. Adherence was defined as meeting the 2014 American Diabetes Association (ADA) guideline based on an individual’s life expectancy. Independent variables included adherence, socio-demographics, diabetes treatment regimen, health status, comorbidities, and lifestyle variables. We used multivariate Cox Proportional Hazards model to estimate the effect of guideline adherence on 10-year survival, controlling for covariates. The mean age of the study sample was 68.8 years and 50.7% were female. When confounding variables were controlled for, guideline adherence is associated with 21.5% lower risk of death (p=0.03). The findings suggest that adherence to the life expectancy adjusted ADA guidelines is important in reducing future premature deaths among older diabetes patients. Therefore, health education about the new guideline is urgently needed to improve adherence in glycemic control among older adults with diabetes. Further research is also warranted on how to balance the needs for glycemic control and the management of comorbidities to maximize quality of life.