{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:36:52Z","timestamp":1782603412640,"version":"3.54.5"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, \u2265\u20098% or &amp;lt; 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical\u00a0Frailty Scale (CFS), diabetic patients were categorized in robust (CFS &amp;lt; 5) and frail (CFS \u2265 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c &amp;lt; 48 mmol\/mol, Tertile 2 (T2) 48-58 mmol\/mol and Tertile 3 (T3) &amp;gt; 58 mmol\/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 1319 older patients (mean age 82.8 \u00b1 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% <jats:italic>vs<\/jats:italic> 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% <jats:italic>vs<\/jats:italic> 12.5%, p&amp;lt;0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% <jats:italic>vs<\/jats:italic> 5%, p=0.001 for T2 and 43.5% <jats:italic>vs<\/jats:italic> 13.3%, p=&amp;lt;0.05 for T3), while no difference was observed among those in T1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Frail patients with HbA1c \u2265 48 mmol\/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.770400","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T07:31:37Z","timestamp":1637220697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture"],"prefix":"10.3389","volume":"12","author":[{"given":"Simone","family":"Paterni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chukwuma","family":"Okoye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia 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