# Investigation of the Relationship Between Glycemic Control and Inflammation–Nutrition Indices in Older Adults with Type 2 Diabetes

## TL;DR

This study finds that inflammation and nutrition markers are better predictors of short-term mortality in older type 2 diabetes patients than blood sugar control.

## Contribution

The study introduces combined inflammation–nutrition indices for improved mortality risk stratification in older type 2 diabetes patients.

## Key findings

- Glycemic control (HbA1c) was not significantly linked to 30-day mortality.
- Higher UHR and EASIX and lower HALP scores were associated with increased mortality risk.
- Combined stratification using HALP, EASIX, and UHR identified high-risk patients with adjusted HRs up to 4.206.

## Abstract

Objective: To investigate the relationship between glycemic control and inflammation–nutrition indices in older adults with type 2 diabetes mellitus and to evaluate their prognostic value for 30-day mortality. Methods: This retrospective cohort study included 372 hospitalized patients aged ≥65 years with type 2 diabetes. Laboratory data were used to calculate the hemoglobin–albumin–lymphocyte–platelet (HALP) score, the endothelial activation and stress index (EASIX), and the uric acid-to-high-density lipoprotein cholesterol ratio (UHR). Cox regression analyses were performed to identify independent predictors of 30-day mortality, and combined stratification models using HALP, EASIX, and UHR were evaluated for risk discrimination. Results: Thirty-day mortality occurred in 57 patients (15.3%). HbA1c levels were not significantly associated with mortality (p = 0.615). Non-survivors had higher UHR, and EASIX, and lower HALP score levels (all p < 0.05). In multivariate Cox regression, age (HR 1.066, 95% CI 1.024–1.109, p = 0.002), length of hospital stay (HR 1.050, 95% CI 1.026–1.074, p < 0.001), ICU admission (HR 2.394, 95% CI 1.227–4.672, p = 0.010), and UHR (HR 1.028, 95% CI 1.013–1.042, p < 0.001) were independent predictors of mortality. Stratification by EASIX and UHR revealed that patients with both high EASIX or UHR and low HALP had the highest mortality risk, with adjusted HRs up to 4.206 (95% CI 1.930–9.166, p < 0.001). Conclusions: Among older adults with type 2 diabetes, short-term mortality is more strongly associated with inflammation, endothelial stress, and nutritional status than with glycemic control. Combined inflammation–nutrition indices (HALP, EASIX, UHR) provide superior risk stratification and help identify high-risk patients early.