The use of the electronic frailty index to optimise HbA1c targets in older individuals with type 2 diabetes.
Introduction Current guidelines advocate individualised HbA1c targets among frail individuals, but the evidence base remains limited. We therefore evaluated whether electronic frailty index (eFI) could improve model performance for mortality and hospital admission, and examined the association betwe...
| Publicado en: | Age & Ageing Vol. 55; no. 6; pp. 1 - 10 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jun2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195099707&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195099707 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2026 vid: 55 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195099707 10.1093/ageing/afag149 ppf: 1 ppct: 9 formats: tig: atl: The use of the electronic frailty index to optimise HbA1c targets in older individuals with type 2 diabetes. aug: au: Crabtree, Thomas S J Aldafas, Rami Qureshi, Nadeem Gordon, Jason Vinogradova, Yana Idris, Iskandar affil: School of Medicine, University of Nottingham, Nottingham, UKRoyal Derby Hospital, University Hospitals of Derby and Burton NHS Trust, Derby, UK School of Medicine, University of Nottingham, Nottingham, UKFaculty of Public Health, College of Health Science, The Saudi Electronic University, Riyadh, Saudi Arabia Division of Primary Care, University of Nottingham, Nottingham, UK Elevate Access Ltd, London, UK School of Medicine, University of Nottingham, Nottingham, UKElevate Access Ltd, London, UK School of Medicine, University of Nottingham, Nottingham, UKRoyal Derby Hospital, University Hospitals of Derby and Burton NHS Trust, Derby, UKCentre of Metabolism, Ageing & Physiology, NIHR, Nottingham BRC, University of Nottingham, Nottingham, UK su: United Kingdom Hospital care Causes of death Old age Risk assessment Predictive tests Glycosylated hemoglobin Secondary analysis Research funding Frail elderly Glycemic control Scientific observation Multivariate analysis Descriptive statistics Kaplan-Meier estimator Longitudinal method Electronic health records Geriatric assessment Type 2 diabetes Confidence intervals Data analysis software Survival analysis (Biometry) Biomarkers Time Proportional hazards models Disease complications sug: subj: Hospital care Causes of death Old age United Kingdom Risk assessment Predictive tests Glycosylated hemoglobin Secondary analysis Research funding Frail elderly Glycemic control Scientific observation Multivariate analysis Descriptive statistics Kaplan-Meier estimator Longitudinal method Electronic health records Geriatric assessment Type 2 diabetes Confidence intervals Data analysis software Survival analysis (Biometry) Biomarkers Time Proportional hazards models Disease complications keyword: aged copyrightHolder:British Geriatrics Society copyrightYear:2026 diabetes mellitus electronic frailty index frailty glycated hemoglobin a HbA1c hospital admission https://dx.doi.org/10.1093/ageing/afag149 individualisation inLanguage:en mortality older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42234809/ type 2 type 2 diabetes aged copyrightHolder:British Geriatrics Society copyrightYear:2026 diabetes mellitus electronic frailty index frailty glycated hemoglobin a HbA1c hospital admission https://dx.doi.org/10.1093/ageing/afag149 individualisation inLanguage:en mortality older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42234809/ type 2 type 2 diabetes ab: Introduction Current guidelines advocate individualised HbA1c targets among frail individuals, but the evidence base remains limited. We therefore evaluated whether electronic frailty index (eFI) could improve model performance for mortality and hospital admission, and examined the association between HbA1c levels and clinical outcomes across frailty strata in large UK primary care population. Methods We included patients with type 2 diabetes mellitus aged ≥65 years within the UK based Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics from 2014–19. Step-wise multivariate Cox regression models were developed for all-cause mortality and hospital admission. Model performance before and after the addition of eFI using Akaike's information criteria (AIC) and Harrell's C statistics was analysed and the risk for both outcomes associated with eFI and HbA1c groups were assessed. Results N = 179 723 individuals (mean age 74.8 ± 7.6 years; diabetes duration 7.3 ± 6.1 years) were included and followed over 1.7 years. Incorporating eFI may improve model performance for both mortality and admission outcomes, reducing AIC (ΔAIC -1423.1 and ΔAIC -308.4 for admission and mortality, respectively) and improving Harrell's C statistics (standard model vs. EFI; 0.616 vs. 0.631 and 0.776 vs. 0.778). All-cause mortality risk was lowest at HbA1c 48–57.9 mmol/mol and increased at both lower and higher HbA1c levels across all frailty groups. The highest risk of hospital admission was consistently observed at HbA1c <48 mmol/mol, particularly in individuals with severe frailty (HR 4.33; 95% CI: 3.64–5.15). Conclusions eFI may enhance model performance for mortality and hospital admissions and may support clinical decision-making by identifying frail individuals for whom intensive glycaemic control is less appropriate. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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