Evidence map›Paper›PMID 41954677›Full record

ArticleAging clinical and experimental research2026

Glycemic control in the context of frailty: a mortality risk assessment in older diabetic patients.

Hong-Jie Yu, Eric Tsz-Chun Lai, Ruby Yu, Jean Woo

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Article in Aging clinical and experimental research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Hong-Jie YuInstitute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.
Eric Tsz-Chun LaiInstitute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China.
Ruby YuJockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China.
Jean WooInstitute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China. jeanwoowong@cuhk.edu.hk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGlycemia control in older diabetic adults is complicated by uncertainty regarding how intensive glycemic control should be, particularly in those with frailty. This study investigated the association between HbA1c levels and all-cause mortality, assessing the modifying effect of frailty. METHODS/

designThis retrospective study used Hong Kong hospitalization data (2012–2021) for older adults. Patients with first-recorded diabetes during 2014–2020 were classified as index cases. Frailty was evaluated using the Hospital Frailty Risk Score (HFRS), derived from two years of hospitalization diagnoses before the index diabetes and categorized as follows: no (HFRS = 0), mild (HFRS <5), and moderate andsevere frailty (HFRS ≥5). Glycemic control was assessed via time-weighted mean HbA1c and early variability of the first three measurements. The relationship between HbA1c, variability, and mortality was examined using multivariable Cox regression, with nonlinear relationships modeled via restricted cubic splines.

resultsA J-shaped curve was observed for HbA1c-mortality association (p-nonlinearity <0.001), with increased risk at low/high extremes, significantly influenced by frailty (p-interaction <0.001). In non-frail patients, lower mortality was noted across an HbA1c range of 5.4%–10.5%, with a minimum at 7.8% (HR = 0.59, 95% CI: 0.56–0.61). For those with moderate andsevere frailty, the safety zone narrowed to 6.1%–9.3%, with a nadir at 7.7% (HR = 0.73, 95% CI: 0.68–0.79). Early glycemic variability significantly affected mortality risk only in non-frail individuals.

conclusionFrailty alters the mortality risk associated with glycemic control, highlighting the need for frailty-stratified management strategies in older diabetic adults to optimize health outcomes.

Indexed as

Diabetes MellitusFrailtyGlycemic ControlAgedAged, 80 and overBlood GlucoseFemaleFrail ElderlyGlycated HemoglobinHong KongHumansMaleRetrospective StudiesRisk AssessmentRisk FactorsBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanDiabetes managementFrailtyGlycemic controlHbA1c levelsMortality risk

Identifiers

PMID41954677
PMCPMC13194240

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.