HbA1c and LDL-C Time in Therapeutic Range: A Study on All-Cause Mortality in Older Adults with Type 2 Diabetes Mellitus and Chronic Kidney Disease

Introduction

Whether long-term attainment of glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) targets improves prognosis in older adults with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remains unclear. We used time in therapeutic range (TTR) to quantify sustained glycemic and lipid control and examined its association, and interaction, with all-cause mortality. Research design and methods: This retrospective multicenter cohort study, based on the Tianjin Health Big Data Platform, included 2005 older (≥65 years) and 5973 younger (<65 years) adults with T2DM-CKD. HbA1c-TTR (target <7.0%) and LDL-TTR (target <1.8 mmol/L) were calculated using the Rosendaal method. After Cox-LASSO covariate selection, multivariable Cox models with and without an interaction term were built, supplemented by RCS, subgroup analyses, and landmark and time-varying covariate sensitivity analyses.