In the
NEWS
Reassessing Tight Glucose Control in Older, Sicker Adults
Photo © BSIP SA / Alamy.
Tight glycemic control increases the risk of hypoglycemia in some, with little benefit.
A
lthough diabetes is a com mon ailment among older adults, there is disagree ment about what constitutes opti mal glucose management. The American Diabetes Association recommends a glycated hemoglo bin (HbA1c) level of less than 7%,
and the American Association of Clinical Endocrinologists en dorses an HbA1c level of less than 6.5%. Several studies have shown, however, that older peo ple, especially those with other serious medical problems, may benefit less from tight glycemic control, which puts them at risk for hypoglycemia and, in turn, increases the risks of dying, cardio vascular disease, falls, dementia, and other adverse consequences. A new study evaluated a broad population, using nation ally representative data from 2001 to 2010 in the National Health and Nutrition Examination Sur vey. Adults 65 years or older were grouped into three health status categories: those receiving dialysis or who had difficulty with two or more activities of daily living (ADLs) were desig nated as having a very complex–
poor health status, those with three or more chronic conditions or two or more instrumentalADL impair ments were designated as having a complex–intermediate health sta tus, and those without these char acteristics were deemed relatively healthy. Of the 1,288 subjects with di abetes and a recorded HbA1c mea surement, 50.7% were relatively healthy, 28.1% had a complex– intermediate health status, and 21.2% had a very complex–poor health status. After comparing HbA1c levels in each group, the study authors determined that patients with diabetes who had achieved an HbA1c level of less than 7% and who also had com plex comorbidities were likely be ing overtreated.—David Carter Lipska KJ, et al. JAMA Intern Med 2015 Jan 12 [Epub ahead of print].
Balancing Ability Correlates with Small Blood Vessel Damage Findings may provide a way to recognize a risk of stroke or cognitive impairment.
O
lder adults who appear healthy but are unable to balance on one leg for 20 seconds may have cerebral small vessel disease, such as lacunar in farction lesions (blocked blood vessels) and microbleeds (minor blood vessel leakage). In the first known study to measure this connection, Japanese researchers found that 34% of people with two lacunar infarctions had trou ble balancing on one leg, as did 16% of those with one lacunar infarction. Similarly, 30% of 16
AJN ▼ April 2015
▼
Vol. 115, No. 4
people with more than two mi crobleeds and 15% with one mi crobleed had lower balancing times. The researchers used magnetic resonance imaging to detect cere bral smallvessel disease. A battery of memory and visual–spatial perception tests evaluated mild cognitive impairment. After ad justment for confounding vari ables, lacunar infarction lesions and microbleeds correlated with the inability to balance on one leg for 20 seconds.
The test appears to be a fast and easy way to recognize an elevated risk of stroke or cognitive impair ment, although study leader Yasu haru Tabara offers a caveat. In an email to AJN, she wrote, “Our re sults cannot simply be applied to the clinical setting as a risk marker, but individuals showing postural instability should receive increased attention. This physical frailty may signal . . . brain abnormalities and cognitive decline.”—Carol Potera Tabara Y, et al. Stroke 2015;46(1):1622. ajnonline.com
NEWS
Reassessing Tight Glucose Control in Older, Sicker Adults
Photo © BSIP SA / Alamy.
Tight glycemic control increases the risk of hypoglycemia in some, with little benefit.
A
lthough diabetes is a com mon ailment among older adults, there is disagree ment about what constitutes opti mal glucose management. The American Diabetes Association recommends a glycated hemoglo bin (HbA1c) level of less than 7%,
and the American Association of Clinical Endocrinologists en dorses an HbA1c level of less than 6.5%. Several studies have shown, however, that older peo ple, especially those with other serious medical problems, may benefit less from tight glycemic control, which puts them at risk for hypoglycemia and, in turn, increases the risks of dying, cardio vascular disease, falls, dementia, and other adverse consequences. A new study evaluated a broad population, using nation ally representative data from 2001 to 2010 in the National Health and Nutrition Examination Sur vey. Adults 65 years or older were grouped into three health status categories: those receiving dialysis or who had difficulty with two or more activities of daily living (ADLs) were desig nated as having a very complex–
poor health status, those with three or more chronic conditions or two or more instrumentalADL impair ments were designated as having a complex–intermediate health sta tus, and those without these char acteristics were deemed relatively healthy. Of the 1,288 subjects with di abetes and a recorded HbA1c mea surement, 50.7% were relatively healthy, 28.1% had a complex– intermediate health status, and 21.2% had a very complex–poor health status. After comparing HbA1c levels in each group, the study authors determined that patients with diabetes who had achieved an HbA1c level of less than 7% and who also had com plex comorbidities were likely be ing overtreated.—David Carter Lipska KJ, et al. JAMA Intern Med 2015 Jan 12 [Epub ahead of print].
Balancing Ability Correlates with Small Blood Vessel Damage Findings may provide a way to recognize a risk of stroke or cognitive impairment.
O
lder adults who appear healthy but are unable to balance on one leg for 20 seconds may have cerebral small vessel disease, such as lacunar in farction lesions (blocked blood vessels) and microbleeds (minor blood vessel leakage). In the first known study to measure this connection, Japanese researchers found that 34% of people with two lacunar infarctions had trou ble balancing on one leg, as did 16% of those with one lacunar infarction. Similarly, 30% of 16
AJN ▼ April 2015
▼
Vol. 115, No. 4
people with more than two mi crobleeds and 15% with one mi crobleed had lower balancing times. The researchers used magnetic resonance imaging to detect cere bral smallvessel disease. A battery of memory and visual–spatial perception tests evaluated mild cognitive impairment. After ad justment for confounding vari ables, lacunar infarction lesions and microbleeds correlated with the inability to balance on one leg for 20 seconds.
The test appears to be a fast and easy way to recognize an elevated risk of stroke or cognitive impair ment, although study leader Yasu haru Tabara offers a caveat. In an email to AJN, she wrote, “Our re sults cannot simply be applied to the clinical setting as a risk marker, but individuals showing postural instability should receive increased attention. This physical frailty may signal . . . brain abnormalities and cognitive decline.”—Carol Potera Tabara Y, et al. Stroke 2015;46(1):1622. ajnonline.com
