Association of Deviation From Glycated Hemoglobin ( HbA1c ) Target in the Guidelines for the Treatment of Diabetes in Older Patients With Place of Care and Interval Between HbA1c Tests Among Older Patients Receiving Home Medical Care

Aim We examined the association of deviation from the glycated hemoglobin (HbA1c) target proposed in the Guidelines for the Treatment of Diabetes in Older Patients in Japan 2016 with the place of care and interval between HbA1c tests among older patients with diabetes. Methods We included patients aged > 65 years receiving biweekly home medical care by physicians from four clinics in Tokyo and Kanagawa Prefecture for > 2 months with ≥ 2 HbA1c tests between November 14, 2016 and November 13, 2021. Among patients meeting the glycemic target according to the above guidelines at the beginning of the study period, we defined those who met the final glycemic target as the “non‐deviating group” and those who missed this target as the “deviating group.” Data were collected on place of care (home or nursing facility), intervals between HbA1c tests, number of oral medications, comorbidities, and activities of daily living (ADL). Multivariate logistic regression analysis was performed using deviation from the HbA1c target (=1) as the outcome. Results Among 1120 patients, we analyzed 834 whose first HbA1c value met the target. The non‐deviating group comprised 763 patients (91.5%), and the deviating group comprised 71 (8.5%). Deviations from the HbA1c target were more frequent among patients who received home care (adjusted odds ratio [aOR] = 2.06, 95% confidence interval [CI]: 1.18–3.61). For each day added to the interval between HbA1c tests, the aOR decreased by approximately 2% (aOR = 0.98, 95% CI: 0.98–0.99). Conclusions The place of care should be considered for older patients with diabetes receiving home medical care.