May 9, 2012 — Middle-aged and elderly patients with diabetes have a high rate of survival even if they live in nursing homes or have multiple comorbidities, according to a study of retirees published online April 6 in the Journals of Gerontology: Series A, Biological Sciences and Medical Sciences.
The findings suggest that even older adults can benefit from interventions to prevent or slow the emergence of complications such as retinopathy, neuropathy, cardiomyopathy, and nephropathy.
"We went into this thinking that people in the limited health group would have substantial mortality but with the exception of patients over age 76 with the poorest health status, all showed strong survival rates," lead author Christine T. Cigolle, MD, MPH, from the University of Michigan Medical School, Ann Arbor, said in a university news release.
According to Dr. Cigolle, interventional success depends on 2 factors: the patient's ability to self-manage their diabetes and the patient living long enough for the benefits to set in.
Researchers found that older patients, who were more likely to have poor health, were also more likely to have trouble controlling their diabetes. However, a larger number of patients were middle-aged with self-management difficulties such as blindness, cognitive impairment, and comorbidities requiring multiple medications.
The study also showed that medically complex patients were likely to live as long as 5 years, suggesting that older patients should be included in future studies to determine whether their outcomes match those of younger and healthier patients with diabetes.
"A struggle in geriatrics has been what interventions are appropriate for older adults. The fact that this group is showing substantial survival means they may well be candidates for continued aggressive care," senior author Caroline S. Blaum, MD, said in the news release.
Study Represents Almost 14 Million US Adults Aged 51 Years and Older
Researchers obtained university Health and Retirement Study data for 3507 patients with diabetes aged 51 years or older. The sample included individuals living in the community as well as those residing in long-term care facilities, representing 13.6 million US adults.
Patients were categorized into 3 groups:
Relatively healthy (n = 1836, representing 7.7 million adults with 2 or fewer comorbidities, no vision or cognitive impairment, dependency in no more than 1 instrumental activity of daily living [IADL] dependency in no more than 1 activity of daily living [ADL], and not living in a long-term care nursing facility).
Self-management difficulty (n = 1164, representing 4.3 million adults with 3 or more comorbidities, severe vision impairment, mild cognitive impairment, or dependency in 2 or more IADLs).
Uncertain/limited benefit group (n = 507, representing 1.6 million adults with dementia, dependency on 2 or more ADLs, or living in a long-stay nursing facility).
Data analysis revealed that the overall 5-year survival rate was 90.8% in the relatively healthy group, 79.4% for the group with self-management difficulties, and 52.5% for the group with uncertain benefit. Survival exceeded 50% for all age groups and clinical groups, with the exception of those aged 76 years and older and in poor health.
"[T]he substantial survival of the Self-Management Difficulty Group, even among the oldest adults, indicates the potential benefit for these patients of pursuing interventions that prevent or delay the onset or worsening of macrovascular and microvascular diabetes complications," the authors write.
Findings also revealed that the number of middle-aged individuals with characteristics likely to make self-management difficult exceeds that of older adults (patients aged 51 - 64 years, 40.8% [1.7 million] vs patients aged 65 - 75 years, 29.8% [1.3 million], and aged 76 years or older, 29.3% [1.2 million]). The authors note that these patients require additional support from the healthcare system or personal caregivers.
Future Studies Should Include a Wider Variety of Patients
Although clinical trials have typically enrolled middle-aged healthy adults, researchers found that relatively healthy adults aged 65 to 75 years had the same 5-year survival as the younger cohort.
Whether these outcomes can be reproduced in older age groups and those with complex health status remains unclear.
"[O]ur findings suggest that older, more clinically complex, adults may well survive long enough to experience treatment benefit, for both primary and secondary prevention...[and] support the inclusion of older complex patients in clinical trials," the authors conclude.
The study was funded by the National Institute on Aging, National Institutes of Health; the Claude D. Pepper Older Americans Independence Center at the University of Michigan; the John A. Hartford Foundation Center of Excellence in Geriatrics at the University of Michigan; and the Ann Arbor VA Geriatric Research, Education and Clinical Center. The authors have disclosed no relevant financial relationships.
J Gerontol A Biol Sci Med Sci. Published online April 6, 2012. Abstract
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Cite this: Older Patients With Diabetes Can Benefit From Interventions - Medscape - May 09, 2012.