Age-related variations in HbA1c improvements: insights from a telehealth-supported community-based intervention.

Porterfield L, Yu X, Amspoker AB, Johnston CA, Naik AD, Virani SS, Ballantyne CM, Balasubramanyam A, Vaughan EM. Age-related variations in HbA1c improvements: insights from a telehealth-supported community-based intervention. Innovation in aging. 2025 Oct 30; 9(11):igaf121, DOI: 10.1093/geroni/igaf121.

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Abstract:

BACKGROUND AND OBJECTIVES: We previously demonstrated that a telehealth-supported community health worker (CHW) intervention significantly improved clinical outcomes in diabetes care. However, the extent to which these benefits vary across different age groups remains unclear. This study evaluated the effectiveness of a CHW-led multidimensional diabetes intervention in reducing HbA1c across age groups. RESEARCH DESIGN AND METHODS: We conducted a retrospective analysis of 10 studies ( < i > n < /i >   =  301) that focused on low-income Hispanic adults with or at risk for type 2 diabetes. The intervention included CHW-participant coaching via mobile Health (mHealth), monthly CHW-led group education, and bidirectional mHealth feedback among participants, CHWs, and clinicians. Outcomes included HbA1c changes from baseline to 6 months and an analysis of CHW-participant conversation data. RESULTS: HbA1c levels improved across all age groups from baseline to 6 months, with statistically significant reductions observed in individuals aged 40-66 years ( < i > p < /i >   <  .05). As age increased from 40 to 49 years ( < i > n < /i >   =  78), HbA1c reductions ranged from -0.83% to -1.18% ( < i > p < /i >   =  .013 to < i > p < /i >   <  .001). By age 50-65 years ( < i > n < /i >   =  182), the trend reversed, with smaller improvements observed as age increased (-1.16% to -0.61%, < i > p < /i >   <  .001 to < i > p < /i >   =  .016). Beyond 65 years ( < i > n < /i >   =  27), HbA1c changes plateaued and were not statistically significant. Medication-related concerns were more prevalent among adults ≥65 years (73.7%) compared to those < 65 years (44.1%) ( < i > p < /i >   =  .014). DISCUSSION AND IMPLICATIONS: HbA1c improved across all ages except in older adults, suggesting that age may play a role in intervention effectiveness. Targeted strategies and further research are needed to understand and address these age-related differences.