Clinical Complexity in Middle-Aged and Older Adults With Diabetes: The Health and Retirement Study
Open accessAbstract
BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions. OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics. DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey. SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million). MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c. RESULTS: Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.). CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.
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The comprehensive assessment described provides a framework to determine goals and therapeutic approaches, including whether referral for diabetes self-management education is appropriate or whether the current plan is too complex for the individual's self-management ability or caregivers.
“The comprehensive assessment described above provides a framework to determine goals and therapeutic approaches (8)(9)(10), including whether referral for diabetes self-management education is appropriate (when complicating factors arise or when transitions in care occur) or whether the current plan is too complex for the individual's self-management ability or the caregivers providing care (11).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [10]
The Discussion says that some middle-aged and older adults face diabetes self-management challenges and may need patient and caregiver education or other assistance. It does not describe a comprehensive assessment for deciding whether a care plan exceeds an individual’s or caregivers’ abilities, nor does it specify when to refer for diabetes self-management education. (LLM, conf=0.84)
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- Authors
- Blaum, C. S., Cigolle, C. T., Boyd, C., Wolff, J. L., Tian, Z., Langa, K. M., & Weir, D. R.
- Affiliations
- University of Michigan (US)
- Johns Hopkins University (US)
- Purdue University West Lafayette (US)
- Corresponding author
- Blaum, Caroline S.
- Weir, David R.
- Venue
- Medical Care
- Published
- 2010-04
- Volume
- 48
- Issue
- 4
- Pages
- 327-334
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC3153504
- OpenAlex
- W2073776654
- Cited by
- 99
- References
- 28
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 14 · 2022: 6 · 2021: 6 · 2020: 15 · 2019: 9 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 7 · 2014: 8 · 2013: 2 · 2012: 7
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1f32ag027649-01)
- National Institute on Aging (R01 AG021493A, R01AG021493, K23AG032910, 1F32AG027649-01, F32 AG027649, U01AG009740, R01AG027010)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, diabetes self-management, clinical complexity, older adults, middle-aged adults, glycemic control, HbA1c, comorbidities, instrumental activities of daily living, activities of daily living dependence, dementia, Health and Retirement Study
- MeSH terms
- Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Self Care, Severity of Illness Index, United States, Treatment Failure, Glycemic Index, Diabetes Complications
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