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This study investigated the association between HbA1c levels and all-cause mortality, assessing the modifying effect of frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\/design<\/jats:title>\n                    <jats:p>This retrospective study used Hong Kong hospitalization data (2012\u20132021) for older adults. Patients with first-recorded diabetes during 2014\u20132020 were classified as index cases. Frailty was evaluated using the Hospital Frailty Risk Score (HFRS), derived from two years of hospitalization diagnoses before the index diabetes and categorized as follows: no (HFRS = 0), mild (HFRS &lt;5), and moderate andsevere frailty (HFRS \u22655). Glycemic control was assessed via time-weighted mean HbA1c and early variability of the first three measurements. The relationship between HbA1c, variability, and mortality was examined using multivariable Cox regression, with nonlinear relationships modeled via restricted cubic splines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A J-shaped curve was observed for HbA1c-mortality association (\n                      <jats:italic>p<\/jats:italic>\n                      -nonlinearity &lt;0.001), with increased risk at low\/high extremes, significantly influenced by frailty (\n                      <jats:italic>p<\/jats:italic>\n                      -interaction &lt;0.001). In non-frail patients, lower mortality was noted across an HbA1c range of 5.4%\u201310.5%, with a minimum at 7.8% (HR = 0.59, 95% CI: 0.56\u20130.61). For those with moderate andsevere frailty, the safety zone narrowed to 6.1%\u20139.3%, with a nadir at 7.7% (HR = 0.73, 95% CI: 0.68\u20130.79). Early glycemic variability significantly affected mortality risk only in non-frail individuals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Frailty alters the mortality risk associated with glycemic control, highlighting the need for frailty-stratified management strategies in older diabetic adults to optimize health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40520-026-03385-5","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T05:14:26Z","timestamp":1775711666000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycemic control in the context of frailty: a mortality risk assessment in older diabetic patients"],"prefix":"10.1007","volume":"38","author":[{"given":"Hong-jie","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Tsz-Chun","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruby","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"3385_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108078","volume":"162","author":"A Sinclair","year":"2020","unstructured":"Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R (2020) Diabetes and global ageing among 65-99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9(th) edition. 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