Identifying Effective Treatment Strategies for Older Adults with Diabetes. Diabetes prevalence increases with age, affecting 10.6% of the U.S. population 45-60 years of age, 19.1% of those 65-74 years, and 17.6% of those 75 and older. Nonetheless, clinical research in diabetes has been primarily conducted in, and guidelines have been derived from, younger subjects. Older patients with diabetes represent a physiologically and sociodemographically heterogeneous population. Recent large clinical trials of intensive glycemic control in subjects with diabetes and cardiovascular disease suggest that older people may experience greater problems with recommended diabetes treatments. Current guidelines for care of diabetes in the geriatric population are largely derived from expert opinion and consensus in the absence of clinical data. The purpose of the proposed work is to initiate research in optimal management of diabetes in the older adults, with emphases on investigation of innovative therapeutic targets that improve diabetes along with quality of life and overall health and identification those who are most likely to derive benefit. Important underrecognized treatment targets include depressed mood, inactivity, and sleep disorders. The expected outcomes of this work will be to: (1) determine the rates and treatment correlates of these problems in a nationally representative probability sample of community-dwelling older adults with diabetes;and (2) develop and analyze a longitudinal cohort to determine trajectories of diabetes progression, cardiovascular disease progression, and death in older adults with diabetes. These goals are prerequisites for shifting the focus of clinical practice from narrow metabolic measures to a broader consideration of contributors to quality of life and overall health. Lessons learned from this project will be used to support further work to develop and test a widely applicable, multifactorial intervention targeting non-traditional treatment targets in the context of traditional medical care to achieve improved glycemia, quality of life, and overall health outcomes in older adults with diabetes. The ultimate goal will be to improve guidelines and overall effectiveness of care for this important, prevalent, and expanding population.

Public Health Relevance

The epidemic of type 2 diabetes mostly affects older people, but treatment recommendations are based on research conducted in younger populations. Recent large clinical trials of intensive glycemic control in subjects with diabetes and cardiovascular disease suggest that older people may experience greater problems with recommended diabetes treatments. The goals of this project are to investigate treatment targets that will improve diabetes as well as quality of life and overall health and determine which older people with diabetes will benefit from treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Small Research Grants (R03)
Project #
5R03DK090196-02
Application #
8279194
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
Project Start
2011-07-01
Project End
2013-06-30
Budget Start
2012-07-01
Budget End
2013-06-30
Support Year
2
Fiscal Year
2012
Total Cost
$63,500
Indirect Cost
$13,500
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Ackroyd, Sarah A; Wexler, Deborah J (2014) Effectiveness of diabetes interventions in the patient-centered medical home. Curr Diab Rep 14:471
Berkowitz, Seth A; Meigs, James B; Wexler, Deborah J (2013) Age at type 2 diabetes onset and glycaemic control: results from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Diabetologia 56:2593-600