Academic Journal
Intensive glycemic control in adults aged 80 years and older: A randomized trial evaluating diabetes complications and competing mortality.
| Τίτλος: | Intensive glycemic control in adults aged 80 years and older: A randomized trial evaluating diabetes complications and competing mortality. |
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| Συγγραφείς: | Yang JH; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Yeh YK; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan., Chen HS; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: chenhs@vghtpe.gov.tw. |
| Πηγή: | Diabetes research and clinical practice [Diabetes Res Clin Pract] 2026 Sep; Vol. 239, pp. 113483. Date of Electronic Publication: 2026 Aug 03. |
| Τύπος έκδοσης: | Comparative Study; Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8508335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8227 (Electronic) Linking ISSN: 01688227 NLM ISO Abbreviation: Diabetes Res Clin Pract Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1993- : Limerick : Elsevier Scientific Publishers Original Publication: Amsterdam : Elsevier Science Publishers B.V., c1985- |
| Ιατρικοί όροι (MeSH): | Diabetes Complications*/mortality , Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/complications , Diabetes Mellitus, Type 2*/mortality , Diabetes Mellitus, Type 2*/blood , Glycemic Control*/methods , Hypoglycemic Agents*/therapeutic use, Diabetic Angiopathies/mortality ; Diabetic Angiopathies/prevention & control ; Glycated Hemoglobin/analysis ; Glycated Hemoglobin/metabolism ; Hypoglycemia/chemically induced ; Aged, 80 and over ; Female ; Humans ; Male ; Blood Glucose ; Prospective Studies |
| Περίληψη: | Aims: To evaluate whether intensive glycemic control reduces microvascular or macrovascular events compared with conservative glycemic targets in independently ambulatory adults aged 80 years or older with type 2 diabetes. Methods: We conducted a prospective, randomized, open-label, single-center trial enrolling independently ambulatory adults aged ≥ 80 years with type 2 diabetes. Participants were assigned (1:1) to an intensive glycemic target (HbA1c < 7 %) or a conservative target (HbA1c < 9 %) and followed for 5 years. Primary outcomes were composite microvascular and macrovascular events. Analyses were done by intention to treat. Cause-specific Cox models and Fine-Gray subdistribution hazard models were used to account for all-cause mortality as a competing event. This trial is registered with ClinicalTrials.gov, NCT00850798. Findings: 206 participants were randomly assigned to intensive (n = 102) or conservative (n = 104) treatment. At 5 years, mean HbA1c was lower in the intensive group than in the conservative group (7·42 % vs 8·21 %; p = 0·005). Intensive therapy did not reduce microvascular events (hazard ratio [HR] 1·24, 95 % CI 0·76-2·04) or macrovascular events (HR 1·02, 0·36-2·92). Competing risk analyses showed no reduction in cumulative incidence of vascular outcomes (subdistribution HR approximately 1·0 for both). The cumulative incidence of death exceeded that of vascular events, indicating that many participants died before potential glycemic benefits could be realized. Severe hypoglycemia requiring hospitalization was more frequent with intensive therapy (7 vs 1 event). Interpretation: In adults aged 80 years or older with type 2 diabetes, intensive glycaemic control improved glycaemic levels but did not reduce vascular events and increased the risk of severe hypoglycaemia. High competing mortality substantially limits the potential long-term benefit of intensive treatment, supporting conservative and individualized glycemic targets in very old adults. Trial Registration: ClinicalTrials.gov Identifier: NCT00850798. (Copyright © 2026. Published by Elsevier B.V.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Ambulatory; Intensive glycemic control; Older adults; Type 2 diabetes |
| Molecular Sequence: | ClinicalTrials.gov NCT00850798 |
| Substance Nomenclature: | 0 (Blood Glucose) 0 (Glycated Hemoglobin) 0 (Hypoglycemic Agents) |
| Entry Date(s): | Date Created: 20260803 Date Completed: 20260829 Latest Revision: 20260909 |
| Update Code: | 20260909 |
| DOI: | 10.1016/j.diabres.2026.113483 |
| PMID: | 42546974 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1872-8227 |
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| DOI: | 10.1016/j.diabres.2026.113483 |