Glycemic control in older subjects with type 2 diabetes mellitus in the Fremantle diabetes study

OBJECTIVES: We investigated whether there were differences in glycemic cont rol in older compared with younger subjects with type 2 diabetes mellitus e nrolled in the Fremantle Diabetes Study, a prospective study of diabetes ca re, control, and complications in an urban setting. DESIGN: Cross-sectional observational study. SETTING: University teaching hospital clinical research center. PARTICIPANTS: A total of 1205 patients with type 2 diabetes mellitus, 404 ( 33.3%) of whom were aged over 70 years and 83 (6.9%) aged over 80 years. MEASUREMENTS: Fasting plasma glucose, HbA(1c), body mass index, and waist/h ip ratio. RESULTS: In multiple linear regression analysis, age was inversely associat ed with glycemic control whereas duration of diabetes and treatment with ei ther oral hypoglycemic agents or insulin were positively associated with gl ycemic control. For most age groups there was a significant worsening of gl ycemic control with duration of diabetes. Octogenarians differed significan tly from younger age groups in that those with longer diabetes duration did not demonstrate the increase in hyperglycemia seen in other age groups. As a result, significantly greater proportions of these oldest diabetic subje cts had satisfactory glycosylated hemoglobin levels compared with younger s ubjects. CONCLUSIONS: Octogenarians do not demonstrate the usual progressive deterio ration of glycemic control with diabetes duration seen in type 2 diabetes m ellitus. The reasons for this difference are unknown but are likely to have clinical significance with regard to therapy and the development of diabet ic complications.