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This study analyzed longitudinal HbA1c trajectories to compare glycemic-mortality associations between older and younger adults, providing real-world evidence for individualized glycemic management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter cohort study utilized the Tianjin Health and Medical Big Data Super Platform (2000-2025), including 2037 older adults as the primary cohort and 6075 younger adults as controls. Group-based trajectory modeling identified latent HbA1c evolution patterns. LASSO regression, multivariate Cox proportional hazards models, and Kaplan\u2013Meier curves assessed mortality associations. A 5-trajectory model refined the optimal glycemic range, with robustness confirmed through subgroup and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median follow-up of 4.56\u2009years, 213 deaths (10.5%) occurred in older adults. Three trajectories were identified: low-stable (38.5%, mean HbA1c 5.12%), medium-declining (40.9%, 6.62%), and high-stable (20.6%, 8.50%). In younger adults, both high-stable and medium-declining trajectories were associated with increased mortality risk; in older adults, only the high-stable trajectory significantly elevated risk (HR 1.73, p\u2009=\u2009.006). Five-trajectory analysis demonstrated that maintaining HbA1c between approximately 6.66%-7.94% did not increase mortality risk, whereas progressive hyperglycemia \u22658.20% significantly increased risk (HR 1.75, p\u2009=\u2009.021). Effective glycemic reduction mitigated hyperglycemia-associated harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Older adults with T2DM and CKD exhibit distinct glycemic-mortality patterns compared to younger patients. Maintaining HbA1c between 6.5%-8% was associated with optimal survival outcomes, whereas sustained hyperglycemia exceeding 8% warrants active intervention. Individualized relaxed glycemic targets may optimize the balance between survival benefit and treatment burden in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glag097","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:32:53Z","timestamp":1775561573000},"source":"Crossref","is-referenced-by-count":0,"title":["Glycemic control targets in older adults with type 2 diabetes and chronic kidney disease: a trajectory-based survival analysis of glycated hemoglobin"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0751-4374","authenticated-orcid":false,"given":"Xiaolong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nephrology, First Medical Center of Chinese PLA General Hospital , Beijing,","place":["China"]},{"name":"State Key Laboratory of Kidney Diseases, First Medical Center of Chinese PLA General Hospital , 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