Diabetes and Aging in a Multi-Ethnic Population

多种族人群的糖尿病和衰老

• 批准号: 8447560
• 负责人: ELBERT S. HUANG
• 金额: $ 53.59万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-13 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8447560
• 关键词: 2,4-thiazolidinedione; Accounting; Address; Adoption; Age; Age-Years; Aging; American; Area; Benefits and Risks; Blood Glucose; Blood Glucose Self-Monitoring; Blood Pressure; California; Caring; Cataloging; Catalogs; Cessation of life; Cholesterol; Clinical; Comorbidity; Complications of Diabetes Mellitus; Data; Deltastab; Dementia; Development; Diabetes Mellitus; Elderly; Enrollment; Ensure; Epidemiologic Studies; Epidemiology; Ethnic group; Event; Fracture; Frequencies; Generations; Geriatrics; Glucose; Goals; Guidelines; Health Planning; Health Policy; Health Services Accessibility; Health Status; Health system; Healthcare; Healthcare Systems; Hypoglycemia; Hypoglycemic Agents; Impaired cognition; Incidence; Individual; Institution; Insulin; Knowledge; Lead; Life; Life Expectancy; Longitudinal Studies; Managed Care; Mental Depression; Methods; Modeling; Natural History; New Agents; Outcome; Patients; Pattern; Patterns of Care; Performance; Pharmaceutical Preparations; Pharmacotherapy; Polypharmacy; Population; Population Study; Prevalence; Prevention; Process; Prospective Studies; Provider; Publishing; Quality of Care; Quality of life; Recommendation; Registries; Relative (related person); Risk; Risk Factors; Safety; Self Care; Societies; Specific qualifier value; Stratification; Subgroup; Sulfonylurea Compounds; Surveys; Syndrome; Thiazolidinediones; Time; Urinary Incontinence; Vulnerable Populations; age group; aging population; analog; arm; base; blood glucose regulation; chronic pain; clinical practice; cohort; ethnic difference; evidence base; falls; functional status; health disparity; health related quality of life; improved; insight; mortality; older patient; policy implication; prognostic; prospective; public health relevance; sex; tool; trend

DESCRIPTION (provided by applicant): Over 40 percent of patients living with diabetes are over 65 years of age, yet very little is known about the risks and benefits of diabetes care in an aging population. This vulnerable population is more heterogeneous than younger patients in terms of functional status, comorbidities and life expectancy, and may need more individualized management of glucose, blood pressure, and cholesterol levels. The special concern that motivates this study (especially since excess deaths led to the discontinuation of the intensive glucose-lowering arm in the ACCORD trial) is the possibility that the risks or burden of intensive and comprehensive diabetes care may outweigh the benefits for some older patients. Geriatric diabetes care guidelines currently recommend that providers consider 5-year life expectancy, risks of hypoglycemia, and geriatric syndromes (e.g., falls, cognitive decline) when setting diabetes treatment goals. While these new recommendations have a clinical rationale, they have not been formally evaluated with data from contemporary epidemiological studies, they lack validated prognostic tools for risk-stratification (predictive 5-year survival models), and their policy implications for quality assessment and health disparities have not been explored. Moreover, little is known about ethnic differences in the natural history of diabetes and their effect on care and outcomes in the elderly. We propose a prospective (2005-2014) examination of a large contemporary, multi-ethnic cohort of ~112,000 older (e60 years of age) diabetes patients identified from the Kaiser Permanente Northern California Diabetes Registry, and sub-studies in a cohort of survey responders (N=9,763). We will: i) characterize the current state of diabetes care management by health status, evaluate quality of life, and estimate rates of traditional complications, hypoglycemia, geriatric syndromes and mortality; ii) describe the interrelationships of hypoglycemia and geriatric syndromes; iii) evaluate the effects of antihyperglycemic therapies and polypharmacy on hypoglycemia, geriatric syndromes, and mortality; iv) create a generalized prediction model for 5-year, all-cause mortality and evaluate the performance of existing prognostic mortality prediction models; and v) explore the health policy implications of the widespread adoption of geriatric diabetes guidelines. This multi-institution, prospective study will expand our understanding of the dynamics of health care and outcomes among elderly diabetes patients. Study findings will provide important insight into the validity and implications of geriatric guidelines, and help ensure that quality improvement efforts for geriatric diabetes care are not at odds with efforts to improve diabetes outcomes and will not increase health disparities within health systems.

描述（由申请人提供）：超过 40% 的糖尿病患者年龄超过 65 岁，但人们对老龄化人口中糖尿病护理的风险和益处知之甚少。这一弱势群体在功能状态、合并症和预期寿命方面比年轻患者更具异质性，可能需要对血糖、血压和胆固醇水平进行更个性化的管理。促使这项研究的特别关注点（特别是因为过多的死亡导致 ACCORD 试验中强化降糖组的终止）是强化和综合糖尿病护理的风险或负担可能超过一些老年患者的益处。老年糖尿病护理指南目前建议医疗服务提供者在设定糖尿病治疗目标时考虑 5 年预期寿命、低血糖风险和老年综合征（例如跌倒、认知能力下降）。虽然这些新建议具有临床依据，但尚未使用当代流行病学研究的数据进行正式评估，缺乏经过验证的风险分层预后工具（预测 5 年生存模型）及其对质量评估和健康差异的政策影响还没有被探索过。此外，人们对糖尿病自然史的种族差异及其对老年人护理和结果的影响知之甚少。我们建议对从 Kaiser Permanente 北加州糖尿病登记处确定的大约 112,000 名老年（e60 岁）糖尿病患者进行前瞻性（2005-2014 年）检查，并在一组调查中进行子研究响应者 (N=9,763)。我们将： i) 通过健康状况描述糖尿病护理管理的现状，评估生活质量，并估计传统并发症、低血糖、老年综合征和死亡率的发生率； ii) 描述低血糖和老年综合征的相互关系； iii) 评估抗高血糖疗法和复方用药对低血糖、老年综合征和死亡率的影响； iv) 创建 5 年全因死亡率的通用预测模型，并评估现有预后死亡率预测模型的性能； v) 探讨广泛采用老年糖尿病指南对卫生政策的影响。这项多机构的前瞻性研究将扩大我们对老年糖尿病患者医疗保健动态和结果的了解。研究结果将为老年病指南的有效性和影响提供重要见解，并有助于确保老年糖尿病护理的质量改进工作不会与改善糖尿病结果的工作相矛盾，并且不会增加卫生系统内的健康差距。

项目成果

Competing demands for time and self-care behaviors, processes of care, and intermediate outcomes among people with diabetes: Translating Research Into Action for Diabetes (TRIAD).

• DOI: 10.2337/dc10-2038
• 发表时间: 2011-05
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: McEwen LN;Kim C;Ettner SL;Herman WH;Karter AJ;Beckles GL;Brown AF
• 通讯作者: Brown AF

Self-reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD.

2 型糖尿病患者自我报告的身体机能和死亡率：来自 TRIAD 的见解。

• DOI: 10.1016/j.jdiacomp.2013.06.004
• 发表时间: 2013
• 期刊: Journal of diabetes and its complications
• 影响因子: 3
• 作者: Ylitalo,KellyR;McEwen,LauraN;Karter,AndrewJ;Lee,Pearl;Herman,WilliamH
• 通讯作者: Herman,WilliamH

Characteristics of insured patients with persistent gaps in diabetes care services: the Translating Research into Action for Diabetes (TRIAD) study.

• DOI: 10.1097/mlr.0b013e3181bd4783
• 发表时间: 2010-01
• 期刊: Medical care
• 影响因子: 3
• 作者: Gregg EW;Karter AJ;Gerzoff RB;Safford M;Brown AF;Tseng CW;Waitzfielder B;Herman WH;Mangione CM;Selby JV;Thompson TJ;Dudley RA
• 通讯作者: Dudley RA

Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD).

• DOI: 10.2337/dc10-2312
• 发表时间: 2011-07
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: McEwen LN;Karter AJ;Curb JD;Marrero DG;Crosson JC;Herman WH
• 通讯作者: Herman WH

Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the Translating Research into Action for Diabetes (TRIAD) study.

• DOI: 10.1186/1472-6823-12-12
• 发表时间: 2012-07-09
• 期刊: BMC endocrine disorders
• 影响因子: 2.7
• 作者: Lu SE;Beckles GL;Crosson JC;Bilik D;Karter AJ;Gerzoff RB;Lin Y;Ross SV;McEwen LN;Waitzfelder BE;Marrero D;Lasser N;Brown AF
• 通讯作者: Brown AF