Papakitsou I, Papazachariou A, Filippatos TD. Association of glycated hemoglobin levels with 3-year mortality in hospitalized older adults with diabetes: The role of frailty. World J Clin Cases 2026; 14(14): 120574 [DOI: 10.12998/wjcc.v14.i14.120574]
Corresponding Author of This Article
Theodosios D Filippatos, MD, PhD, Associate Professor, School of Medicine, University of Crete, Panepistimiou Ave, Crete, Heraklion 71003, Greece. filtheo@uoc.gr
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Geriatrics & Gerontology
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Observational Study
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May 16, 2026 (publication date) through Apr 27, 2026
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World Journal of Clinical Cases
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Papakitsou I, Papazachariou A, Filippatos TD. Association of glycated hemoglobin levels with 3-year mortality in hospitalized older adults with diabetes: The role of frailty. World J Clin Cases 2026; 14(14): 120574 [DOI: 10.12998/wjcc.v14.i14.120574]
World J Clin Cases. May 16, 2026; 14(14): 120574 Published online May 16, 2026. doi: 10.12998/wjcc.v14.i14.120574
Association of glycated hemoglobin levels with 3-year mortality in hospitalized older adults with diabetes: The role of frailty
Ioanna Papakitsou, Andria Papazachariou, Theodosios D Filippatos
Ioanna Papakitsou, Andria Papazachariou, Theodosios D Filippatos, School of Medicine, University of Crete, Crete, Heraklion 71003, Greece
Ioanna Papakitsou, Andria Papazachariou, Theodosios D Filippatos, Department of Internal Medicine, University Hospital of Heraklion, Heraklion 71500, Greece
Author contributions: Papakitsou I contributed to study design, data collection, statistical analysis, and manuscript drafting; Papazachariou A contributed to data collection, data interpretation, statistical analysis and manuscript revision; Filippatos TD conceived and supervised the study, contributed to study design, data interpretation, and critically revised the manuscript for important intellectual content; and all authors approved the final version of the manuscript.
Institutional review board statement: The original study protocol, including the present sub-analysis, was approved by the Ethics Committee of the University Hospital of Heraklion (approval code 716/16-01-2019).
Informed consent statement: All study participants, or either legal guardians, provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: There is no additional data available.
Corresponding author: Theodosios D Filippatos, MD, PhD, Associate Professor, School of Medicine, University of Crete, Panepistimiou Ave, Crete, Heraklion 71003, Greece. filtheo@uoc.gr
Received: March 3, 2026 Revised: March 26, 2026 Accepted: April 15, 2026 Published online: May 16, 2026 Processing time: 56 Days and 5.6 Hours
Abstract
BACKGROUND
Tight glycemic control in older adults with type 2 diabetes mellitus (T2DM) has been associated with increased risk of hypoglycemia, functional decline, and mortality, particularly in frail individuals. However, real-world glycemic patterns and their prognostic implications across different frailty and multimorbidity states remain unclear.
AIM
To evaluate glycemic control at admission in very old adults with T2DM according to frailty and comorbidity burden, and to investigate the association between glycated hemoglobin (HbA1c) levels and 3-year post discharge-mortality.
METHODS
This study is a sub-analysis of a prospective cohort study including hospitalized patients aged ≥ 65 years admitted to a medical ward. Baseline demographic, clinical, and laboratory data were collected during hospitalization. Frailty was assessed using the Clinical Frailty Scale (CFS), functional status using the Katz Index, and comorbidity burden using the Charlson Comorbidity Index. Patients were followed for three years after discharge. HbA1c was analyzed as both a categorical (< 6.5%, 6.5%-8.0%, > 8.0%) and continuous variable. Multivariable logistic regression models were used to examine the association between HbA1c and 3-year post discharge all-cause mortality.
RESULTS
A total of 430 hospitalized older adults with type 2 diabetes (mean age 81.5 ± 7.3 years; 55.8% women) were included. Severe frailty (CFS ≥ 6) was present in 46.7% of participants. The median HbA1c was 6.1% (interquartile range: 5.5-7.1), with no significant differences across frailty, functional status, or comorbidity categories. Among them, 62 patients died during hospitalization; the 368 remaining patients exhibited a 54.9% 3-year post-discharge mortality. Lower HbA1c levels were independently associated with increased 3-year mortality (odds ratio per 1% HbA1c decrease 1.24, 95%CI: 1.05-1.46; P = 0.010), with significant effect modification by frailty (interaction OR: 0.97 per CFS unit; 95%CI: 0.93-0.99; P = 0.034), indicating an approximate 3% relative reduction in the strength of the HbA1c-mortality association per CFS increment.
CONCLUSION
In very old medical inpatients with T2DM, glycemic control was similar irrespective of frailty, functional status, or comorbidity burden. Lower HbA1c levels were independently associated with increased 3-year-post-discharge-mortality, with significant effect modification by frailty, supporting a frailty-informed approach to glycemic targets.
Core Tip: In very old hospitalized adults with type 2 diabetes, glycemic control did not differ according to frailty or comorbidity burden, suggesting a lack of individualized treatment in routine practice. Lower glycated hemoglobin levels were independently associated with increased 3-year mortality, particularly in less frail individuals. These findings support a frailty-informed approach to glycemic targets in very old patients.
