CoChat
Sign Up
Cited by 21Chronic Disease Management StrategiesFrailty in Older AdultsDiabetes Management and Education

Reexamining the classification of older adults with diabetes by comorbidities and exploring relationships with frailty, disability, and 5-year mortality

Open access
Leung, Vania, Wroblewski, Kristen, Schumm, L Philip, Huisingh-Scheetz, Megan, Huang, Elbert S·2021·The Journals of Gerontology: Series A
DOI 10.1093/gerona/glab141PMC PMC8514058
Open this paper in CoChat — free account

Abstract

Background: Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to reexamine the 2005–2006 classification systems in participants who are now 5 years older. Methods: We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project. The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010–2011 LCA model to that of 2005–2006. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and 5-year mortality. Results: Both 2005–2006 LCA and the 2010–2011 LCA model fit 3 similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability = 0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality. Conclusions: We reconfirmed 3 latent classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/gerona/glab141

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.

    “Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [61]

    The Results report that the cardiovascular Class 3 had more frailty than the healthier Class 1 and the highest 5-year mortality. But Class 2—not Class 3—had the highest frailty prevalence (0.64 versus 0.29), so the claim that the cardiovascular class had the highest risk of both outcomes is contrary to the paper. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.

    “The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [61]

    The Results identify Class 2 as the geriatric-syndrome profile and Class 3 as the cardiovascular profile, with the stated conditions generally more prevalent in those classes. But the detailed Results report an exception: in 2005–2006, arthritis prevalence was higher in Class 3 (0.83) than in Class 2 (0.74), so Class 2 did not always have the highest arthritis prevalence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, while the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.

    “The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, while the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [69]

    The Results identify Class 2 as the geriatric-profile class and Class 3 as the cardiovascular-profile class, with the stated conditions generally more prevalent in those respective classes. However, the detailed Results report that arthritis was more prevalent in Class 3 than Class 2 in the 2005–2006 model (0.83 versus 0.74), so the unqualified claim about arthritis is not supported for both models. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.

    “Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality.”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [69]

    The Results report that the cardiovascular class (Class 3) had more frailty than the healthier Class 1 and the highest 5-year mortality. But Class 2—not the cardiovascular class—had the highest frailty prevalence (0.64 versus 0.29 for Class 3), so the claim overstates that part. (LLM, conf=0.94)

    Experimental — accuracy not yet measured

  • Ongoing empiric research on the classification of older adults with diabetes based on comorbid illness has repeatedly found three major classes of patients: a healthy, a geriatric, and a cardiovascular class.

    “Ongoing empiric research on the classification of older adults with diabetes based on comorbid illness has repeatedly found three major classes of patients: a healthy, a geriatric, and a cardiovascular class (9,61,66).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [61]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 23

  1. [1]1. Roberts AW, Ogunwole SU, Blakeslee L, Rabe MA.. The Population 65 Years and Older in the United States: 2016. US Department of Commerce, Economics and Statistics Administration; 2018. [Google Scholar]
  2. [2]2. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the united states, 1988–2012. JAMA. 2015;314(10):1021–1029. doi: 10.1001/jama.2015.10029 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  3. [3]3. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care. 2012;35:2650–2664. doi: 10.2337/dc12-1801 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  4. [4]4. Duckworth W, Abraira C, Moritz T, et al. ; VADT Investigators . Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–139. doi: 10.1056/NEJMoa0808431 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  5. [5]5. Moreno G, Mangione CM. Management of cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: 2002–2012 literature review. J Am Geriatr Soc. 2013;61(11):2027–2037. doi: 10.1111/jgs.12513 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  6. [6]6. Sinclair AJ, Paolisso G, Castro M, et al. European diabetes working party for older people 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37(suppl 3):27. doi: 10.1016/S1262-3636(11)70962-4 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  7. [7]7. Sinclair AJ, Abdelhafiz A, Dunning T, et al. An international position statement on the management of frailty in diabetes mellitus: summary of recommendations 2017. J Frailty Aging. 2018;7:10–20. doi: 10.14283/jfa.2017.39 [DOI] [PubMed] [Google Scholar] · DOI
  8. [8]8. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–853. doi: 10.1016/S0140-6736(98)07019-6 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  9. [9]9. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–2559. doi: 10.1056/NEJMoa0802743 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  10. [10]10. Patel A, MacMahon S, Chalmers J, et al. ; ADVANCE Collaborative Group . Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–2572. doi: 10.1056/NEJMoa0802987 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  11. [11]11. Huang ES. Management of diabetes mellitus in older people with comorbidities. BMJ. 2016;353:i2200. doi: 10.1136/bmj.i2200 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  12. [13]13. Blaum C, Cigolle CT, Boyd C, et al. Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. Med Care. 2010;48:327–334. doi: 10.1097/mlr.0b013e3181ca4035 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  13. [14]14. Cigolle CT, Kabeto MU, Lee PG, Blaum CS. Clinical complexity and mortality in middle-aged and older adults with diabetes. J Gerontol A Biol Sci Med Sci. 2012;67:1313–1320. doi: 10.1093/gerona/gls095 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  14. [15]15. Pilla SJ, Schoenborn NL, Maruthur NM, Huang ES. Approaches to risk assessment among older patients with diabetes. Curr Diab Rep. 2019;19:59. doi: 10.1007/s11892-019-1172-z [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  15. [16]16. LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab. 2019;104:1520–1574. doi: 10.1210/jc.2019-00198 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  16. [17]17. Smith S, Jaszczak A, Graber J, et al. Instrument development, study design implementation, and survey conduct for the national social life, health, and aging project. J Gerontol B Psychol Sci Soc Sci. 2009;64(suppl 1):i20–i29. doi: 10.1093/geronb/gbn013 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  17. [18]18. Gregg FT, O’Doherty K, Schumm LP, McClintock MK, Huang ES. Glycosylated hemoglobin testing in the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci. 2014;69(suppl 2):S198–S204. doi: 10.1093/geronb/gbu118 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  18. [19]19. Qato DM, Schumm LP, Johnson M, Mihai A, Lindau ST. Medication data collection and coding in a home-based survey of older adults. J Gerontol B Psychol Sci Soc Sci. 2009;64(suppl 1):i86–i93. doi: 10.1093/geronb/gbp036 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  19. [20]20. Vasilopoulos T, Kotwal A, Huisingh-Scheetz MJ, Waite LJ, McClintock MK, Dale W. Comorbidity and chronic conditions in the National Social Life, Health and Aging Project (NSHAP), Wave 2. J Gerontol B Psychol Sci Soc Sci. 2014;69(suppl 2):S154–S165. doi: 10.1093/geronb/gbu025 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  20. [21]21. Huisingh-Scheetz M, Kocherginsky M, Schumm PL, et al. Geriatric syndromes and functional status in NSHAP: rationale, measurement, and preliminary findings. J Gerontol B Psychol Sci Soc Sci. 2014;69(suppl 2):S177–S190. doi: 10.1093/geronb/gbu091 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  21. [22]22. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–M94. doi: 10.1093/geronj/49.2.m85 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  22. [24]24. Raftery AE. Bayesian model selection in structural equation models. In: Bollen KA, Long JS, eds. Reprinted in testing structural equation models. Newbury Park, CA; 1993:163–180. [Google Scholar]
  23. [25]25. Skrondal A, Rabe-Hesketh S.. Generalized Latent Variable Modeling: Multilevel, Longitudinal, and Structural Equation Models. CRC Press; 2004. [Google Scholar]

Cited by

Sorted by citations

Authors
Leung, V., Wroblewski, K., Schumm, L. P., Huisingh-Scheetz, M., & Huang, E. S.
Affiliations
  • University of Illinois Chicago (US)
  • University of Chicago (US)
Corresponding author
Leung, Vania
ORCID
Venue
The Journals of Gerontology: Series A
Publisher
Oxford University Press (OUP)
Published
2021-05-18
Volume
76
Issue
11
Pages
2071-2079
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
DOI
10.1093/gerona/glab141
PMC
PMC8514058
OpenAlex
W3160058700
Cited by
21
References
2
Citations by year
2026: 3 · 2025: 6 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 2
FWCI
2.16
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (K23AG049106)
  • National Institutes of Health (R01AG021487, R37AG030481, R01AG033903, R01AG043538, R01AG048511, R01AG060756, 2K24AG069080-06, 5P30DK092949-09)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes in older adults, comorbidity profiles, frailty, disability, mortality, risk stratification, geriatric syndromes, cardiovascular comorbidity, obesity, latent class analysis, National Social Life, Health, and Aging Project
MeSH terms
Frailty, Aged, Aging, Diabetes Mellitus, Disabled Persons, Persons with Disabilities, Humans, Geriatric Assessment, Comorbidity, Frail Elderly

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review