1261-P: Is Higher A1C in Older Adults with Cognitive and Functional Impairment Enough to Protect against Hypoglycemia?
Bibliographic record
Abstract
Background: Older adults with diabetes with cognitive or functional impairment are recommended to have higher A1C. However, impact of higher A1C on CGM metrics in impaired and unimpaired patients are not well studied. Methods: A cross-sectional analysis of baseline data across three studies was performed in older adults (age ≥65 years) with diabetes on insulin. Demographic and clinical characteristics including cognitive and functional status, and continuous glucose monitoring (CGM) data were reviewed. Results: Data on 209 participants stratified as unimpaired (MoCA ≥26 and no frailty) and impaired (MoCa <26 and/or frailty ≥1) were analyzed. Compared to the 66 patients with unimpaired status, the 143 patients with impaired status were more likely to live alone, had greater hypoglycemia fear, and high burden of comorbidities (Table 1). Although the impaired patients had higher HbA1c (7.9% ), both unimpaired and impaired patients had high burden of hypoglycemia (time spent <70 mg/dL)(4.4% and 3.2% respectively) and extreme hyperglycemia (time spent >250 mg/dL(13% and 19% respectively). Conclusion: Liberal A1C goals based on cognitive and/or functional impairment may not protect against risk of hypoglycemia and extreme hyperglycemia in older adults. CGM should be considered for diabetes care decisions in the older population independent of health status. Disclosure C.D. Conery: None. C. Slyne: None. K. Loo Urbina: None. N. Krakoff: None. H. Brabant: None. M. Munshi: Consultant; Sanofi. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. Funding The Leona M. and Harry B. Helmsley Charitable Trust
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".