Data-driven classification of health status of older adults with diabetes: the diabetes and aging study
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Background We set out to identify empirically-derived health status classes of older adults with diabetes based on clusters of comorbid conditions which are associated with future complications. Methods We conducted a cohort study among 105,786 older (≥65 years of age) adults with type 2 diabetes enrolled in an integrated healthcare delivery system. We used latent class analysis of 19 baseline comorbidities to derive health status classes and then compared incident complication rates (events per 100 person-years) by health status class during 5 years of follow-up. Complications included infections, hyperglycemic events, hypoglycemic events, microvascular events, cardiovascular events, and all-cause mortality. Results Three health status classes were identified: Class 1 (58% of the cohort) had the lowest prevalence of most baseline comorbidities, Class 2 (22%) had the highest prevalence of obesity, arthritis, and depression, and Class 3 (20%) had the highest prevalence of cardiovascular conditions. The risk for incident complications was highest for Class 3, intermediate for Class 2 and lowest for Class 1. For example, the age, sex and race-adjusted rates for cardiovascular events (per 100 person-years) for Class 3, Class 2 and Class 1 were 6.5, 2.3, and 1.6, respectively; 2.1, 1.2, 0.7 for hypoglycemia; and 8.0, 3.8, and 2.3 for mortality. Conclusions Three health status classes of older adults with diabetes were identified based on prevalent comorbidities and were associated…
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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 [66]
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 [66]
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 [66]
Ongoing empiric research on the classification of older adults with diabetes based on comorbid illness has repeatedly found three major classes: 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 individuals: a healthy, a geriatric, and a cardiovascular class (10,63,68).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [68]
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 [75]
Empiric research on classification of older adults with diabetes based on comorbid illness has suggested three broad classes: a healthy, a geriatric, and a cardiovascular class.
“Empiric research on the classification of older adults with diabetes based on comorbid illness has suggested three broad classes of individuals: a healthy, a geriatric, and a cardiovascular class”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [75]
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 [75]
Cites
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1504720 · Cited by 12,315 · see citing works
Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F. E., Nauck, M. A., Nissen, S. E., Pocock, S., Poulter, N. R., Ravn, L. S., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1603827 · Cited by 7,629 · cited 1× · see citing works
“In the last decade, the approach to diabetes management has been further transformed by a series of cardiovascular outcome trials that have revealed the benefits of newer glucose-lowering agents such as SGLT-2 inhibitors and GLP-1 receptor agonists compared to placebo.(13,14) With ongoing developments in diabetes trea…”
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes
The Look AHEAD Research Group (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1212914 · Cited by 2,908 · see citing works
9. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s009 · Cited by 972 · see citing works
Latent Variable Models and Factor Analysis: A Unified Approach
Bartholomew, D., Knott, M., & Moustaki, I. (2011) · Wiley Series in Probability and Statistics · doi:10.1002/9781119970583 · Cited by 842 · see citing works
Ethnic disparities in diabetic complications in an insured population
Karter, A. J. (2002) · JAMA · doi:10.1001/jama.287.19.2519 · Cited by 840 · see citing works
Self-citationLifestyle change and mobility in obese adults with type 2 diabetes
Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1110294 · Cited by 301 · see citing works
Huang, E. S., Zhang, Q., Gandra, N., Chin, M. H., & Meltzer, D. O. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-1-200807010-00005 · Cited by 165 · see citing works
Self-citationClassification of Older Adults Who Have Diabetes by Comorbid Conditions, United States, 2005–2006
Laiteerapong, N., Iveniuk, J., John, P., Laumann, E., & Huang, E. (2012) · Preventing Chronic Disease · doi:10.5888/pcd9.110287 · Cited by 44 · see citing works
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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
13. Older Adults: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s013 · Cited by 161 · see citing works
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
- Huang, E. S., Liu, J. Y., Lipska, K. J., Grant, R. W., Laiteerapong, N., Moffet, H. H., Schumm, L. P., & Karter, A. J.
- Affiliations
- University of Chicago (US)
- Kaiser Permanente (US)
- Yale University (US)
- Corresponding author
- Huang, Elbert S.
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2023-03-08
- Volume
- 71
- Issue
- 7
- Pages
- 2120-2130
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC10363208
- OpenAlex
- W4323532335
- Cited by
- 11
- References
- 9
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 4
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American Geriatrics Society (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Knowledge@UChicago (University of Chicago) (submittedVersion)
- University of Chicago
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092924, P30 DK092949)
- National Institute on Aging (K24AG069080, R01 AG063391)
- 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
- type 2 diabetes, older adults, comorbidities, latent class analysis, diabetes complications, cardiovascular events, hypoglycemia, all-cause mortality, obesity, arthritis, depression
- MeSH terms
- Aged, Aged, 80 and over, Aging, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Health Status, Humans, Cohort Studies
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