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Cited by 13Palliative Care and End-of-Life IssuesFrailty in Older AdultsChronic Disease Management Strategies

Development and validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the diabetes and aging study

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Karter, Andrew J., Parker, Melissa M., Moffet, Howard H., Lipska, Kasia J., Laiteerapong, Neda, Grant, Richard W., Lee, Catherine, Huang, Elbert S.·2023·Journal of General Internal Medicine
DOI 10.1007/s11606-023-08219-yPMC PMC10228886
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Abstract

Background Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed. Objective Develop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy. Design Predictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort. Participants Adults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020). Main measures Demographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality. Key results In the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration. Conclusions LEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation.

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  • The Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years.

    “Notably, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years (52).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [52]

  • These data may be a useful starting point to inform decisions about selecting less stringent glycemic goals.

    “These data may be a useful starting point to inform decisions about selecting less stringent glycemic goals (56,57).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [56]

  • The LEAD tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years.

    “Notably, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years (56).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [56]

  • The Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes.

    “The Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years (62).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [62]

  • A high risk score on the LEAD tool was strongly associated with having a life expectancy of <5 years.

    “The Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high risk score was strongly associated with having a life expectancy of <5 years (62).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [62]

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Sorted by citations

Authors
Karter, A. J., Parker, M. M., Moffet, H. H., Lipska, K. J., Laiteerapong, N., Grant, R. W., Lee, C., & Huang, E. S.
Affiliations
  • Kaiser Permanente (US)
  • Yale University (US)
  • University of Chicago (US)
Corresponding author
Karter, Andrew J.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2023-05-30
Volume
38
Issue
13
Pages
2860-2869
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-023-08219-y
PMC
PMC10228886
OpenAlex
W4378783177
Cited by
13
References
9
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 3
FWCI
3.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • NIA (R01 AG063391)
  • NIDDK (P30 DK092924, P30 DK092949)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
life expectancy estimation, diabetes in older adults, mortality prediction, risk scoring tool, shared decision-making, clinical trial inclusion, resource allocation
MeSH terms
Aged, Aging, Diabetes Mellitus, Female, Humans, Life Expectancy, Male, Retrospective Studies, Risk Factors

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