Normal mortality in the elderly with diabetes under strict glycemic and blood pressure control: Outcome of 6-year prospective study

Mortality, macroangiopathic events and end-stage renal disease (ESRD) in the elderly under long-term, intensive multifactorial diabetes control were prospectively investigated. Three hundred and eighty-eight elderly patients (≥65 years) with type 2 diabetes (the mean age 72.9 years, men/women ratio 176/212) were followed-up for 6 years with HbA1c 7.0%, BP 145/80 mmHg and total cholesterol<240 mg/dl as targets. The mean baseline HbA1c was 6.8%, BP 137/74 mmHg and total cholesterol 196 mg/dl, and corresponding values upon closing 6.9%, 134/72 mmHg and 188 mg/dl respectively. Mortality rate was 19.6%/6 years (1.01 times that of age- and sex-matched general population), and macroangiopathic events developed in 142 (36.6%) and ESRD in 9 (2.3%). Independent risk factors: low glomerular filtration rate (GFR) (P < 0.001), prior stroke (P = 0.002), age (P = 0.001) and ΔBMI (P = 0.001) for mortality; prior stroke (P < 0.001) and coronary events (P = 0.042), high LDL-cholesterol (P = 0.004), low GFR (P = 0.028), and past maximum BMI (P = 0.032) and age (P = 0.019) for macroangiopathy; low GFR (P < 0.001) for ESRD. No smoking was an independent protective factor for mortality (P = 0.008). In conclusion, normal mortality was attained in the elderly under intensive mutifactorial diabetes control. Renal dysfunction, prior stroke, high LDL-cholesterol, and prior obesity were prominent risks for mortality, macroangiopathy and/or ESRD.