Diabetes and Aging in a Multi-Ethnic Population

多种族人群的糖尿病和衰老

• 批准号: 8055894
• 负责人: ELBERT S. HUANG
• 金额: $ 56.93万
• 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 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8055894
• 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; 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，但对老龄化人群中糖尿病护理的风险和益处知之甚少。就功能状况，合并症和预期寿命而言，这种脆弱的人群比年轻患者更异质，并且可能需要对葡萄糖，血压和胆固醇水平进行更多个性化的管理。激发这项研究的特别关注（尤其是因为过多的死亡导致协议试验中降低葡萄糖的降解臂的停用）是，强化和全面的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提供者在设定糖尿病治疗目标时考虑5年的预期寿命，低血糖风险和老年综合症（例如，瀑布，认知能力下降）。尽管这些新建议具有临床原理，但尚未通过当代流行病学研究的数据进行正式评估，但它们缺乏验证的预后工具的风险分解工具（预测性的5年生存模型），并且尚未探索它们对质量评估和健康差异的政策影响。此外，关于糖尿病自然史的种族差异及其对老年人的护理和结果的影响知之甚少。我们提出了一项预期的（2005-2014）检查，对大型现代，多民族的同类群体，约112,000名较大的（E60岁）糖尿病患者，可从Kaiser Permanente Northerente北加州糖尿病注册表中鉴定出来，并在调查人员的队列中（n = 9,763）中的子阶段。我们将：i）通过健康状况，评估生活质量以及传统并发症，低血糖，老年综合症和死亡率的估计率来表征糖尿病护理管理的当前状态； ii）描述低血糖和老年综合征的相互关系； iii）评估抗血糖疗法和多药对低血糖，老年综合征和死亡率的影响； iv）为5年全因死亡率创建广义预测模型，并评估现有的预后死亡率预测模型的性能；和v）探讨了老年糖尿病指南的广泛采用的健康政策影响。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和结果动态的理解。研究结果将为老年指南的有效性和含义提供重要的见解，并有助于确保老年糖尿病护理的质量改善努力与改善糖尿病结果的努力不一致，并且不会增加健康系统中的健康差异。