Clinical complexity and mortality in middle-aged and older adults with diabetes
Open accessAbstract
BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit. METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models. RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%. CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.
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Older adults with diabetes categorized as having complex or intermediate health are heterogeneous with respect to their function and life expectancy.
“Older adults with diabetes categorized as having complex or intermediate health (Table 13.1) are heterogeneous with respect to their function and life expectancy (61)(62)(63).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [62]
The Abstract describes adults with diabetes as heterogeneous across clinical groups, and the Results report different five-year survival probabilities for those groups. But the paper uses different group labels from “complex or intermediate health,” does not establish heterogeneity of function within those categories, and explicitly says its analyses examined survival and mortality, not life expectancy (Results; page unavailable). (LLM, conf=0.86)
Experimental — accuracy not yet measuredOlder adults with diabetes categorized as having complex or intermediate health are heterogeneous with respect to their function and life expectancy.
“Older adults with diabetes categorized as having complex or intermediate health (Table 13.2) are still heterogeneous with respect to their function and life expectancy”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [70]
The Abstract describes adults with diabetes as heterogeneous across clinical groups, and the Results report different five-year survival probabilities for those groups. But the paper does not establish variation in function and life expectancy within the cited complex or intermediate categories; it explicitly says its analyses examined survival and mortality, not life expectancy (Results; page unavailable). (LLM, conf=0.86)
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Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.7345 · Cited by 408 · see citing works
13. Older Adults: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s013 · Cited by 209 · see citing works
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13. Older Adults: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s013 · Cited by 87 · see citing works
- Authors
- Cigolle, C. T., Kabeto, M. U., Lee, P. G., & Blaum, C. S.
- Affiliations
- University of Michigan (US)
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04-06
- Volume
- 67
- Issue
- 12
- Pages
- 1313-1320
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC3670162
- OpenAlex
- W2136432753
- Cited by
- 34
- References
- 3
- Citations by year
- 2025: 4 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 6 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k08ag031837-05)
- Agency for Healthcare Research and Quality (1r24hs019459-01)
- National Institute on Aging (U01 AG 09740, K08-AG-031837, 5K08AG031837, U01AG009740)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, mortality, middle-aged adults, older adults, clinical complexity, diabetes self-management, comorbidities, health status, survival, Health and Retirement Study
- MeSH terms
- Activities of Daily Living, Aged, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Self Care, Comorbidity, Proportional Hazards Models, Diabetes Complications
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