Objective: Target HbA1c values given in the most National Therapeutic Guidelines for patients with

diabetes and cut-off HbA1c values for diabetes diagnosis are usually not taking the age of the
respective patients into account; despite the fact that an increase in HbA1c in subjects without
diabetes with age is known for some time. In order to further quantify the association between age
and HbA1c in non-diabetic subjects an analysis of one German register was performed.
Methods: In this cross-sectional study we analyzed data from 7 699 visits of 2 921 patients without
diabetes (age 46.6 y [range 1893 y]; 69.1 % women; BMI 27.6 6.4 kg/m) who had at least one
HbA1c and blood glucose measurement. Data were drawn from an electronic patient record system
(EMIL) in which data were collected between 01/1992 and 01/2014. The patients were divided in 6
age groups (< 30 years [n = 1 057]; > 3040 years [n = 1 160]; > 4050 years [n = 1 693]; > 5060
years [n = 1 523]; > 6070 years [n = 1 310]; > 70 years [n = 956]) and the HbA1c values of these
groups were compared. Patients with: gestational diabetes, use of systemic glucocorticoids,
malignant neoplasm, age < 18 y at time of first visit and IGT were excluded. HbA1c measurements
were DCCT adjusted.
Results: Patients with age > 70 years have a 0.47 % [5.14 mmol/mol] higher HbA1c compared to
those < 30 years. The mean HbA1c of the age groups was: < 30 4.98 % [30.96 mmol/mol], > 3040
5.07 % [31.99 mmol/mol], > 4050 5.17 % [33.10 mmol/ mol], > 5060 5.33 % [34.79 mmol/mol], >
6070 5.42 % [35.79 mmol/mol] and > 70 years 5.45 % [36.10 mmol/mol]. In a multiple linear model
the regression coefficient for each year of age increase was = 0.0074 (p < 0.001); thus age results
in an increase of 0.074 % in HbA1c per decade.
Conclusion: HbA1c increases significantly with ageing in people without diabetes. The use of
different cut-off values for every age range for diagnosis of diabetes should be discussed.

 Conclusions
HbA1c increases significantly with ageing in people without
diabetes.
Age-specific reference ranges for HbA1c require further
investigation, so that the use of an adjusted cut-off value for every
age range for the diagnosis of diabetes can be questioned more
critical. Overdiagnosis and overtreatment of patients should be
avoided in any case, because it stresses the patient, the doctor
and health care system.
Novelty Statement
HbA1c increases significant with age in people without diabetes.
HbA1c of people with age > 70 years is 0.47 % higher compared
to people younger than 30 years. The increase is not explained by
drug treatment. Diagnostic criteria and HbA1c goals for old people
with diabetes should consider an age depended increase.

 Abstract
Animal studies suggested that there is an independent
bone-osteocalcin-gonadal
axis,
except
of
the
hypothalamic-pituitary-gonadal axis. Based on this
hypothesis, the higher osteocalcin during the high bone
turnover should be followed by higher testosterone
formation. Yet such clinical evidence is limited. The
patients with uncontrolled hyperthyroidism are proper
model with high bone turnover. If this hypothesis is true,
there should be high testosterone level in patients with
uncontrolled
hyperthyroidism.
Therefore,
Graves
disease patients were recruited to study the correlation
between osteocalcin and testosterone.

 Conclusion: The present study suggests that

testosterone was positively correlated with serum
osteocalcin in male hyperthyroidism patients,
which indirectly supported the topic that serum
osteocalcin participated in the regulation of sex
hormone.