Assessment of Barriers to Improve Diabetes Management in Older Adults
Open accessAbstract
OBJECTIVE: To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control. The American Diabetes Association guidelines recommend the assessment of age-specific barriers. However, the effect of such strategy on outcomes is unknown. RESEARCH DESIGN AND METHODS: We randomized 100 subjects aged ≥69 years with poorly controlled diabetes (A1C >8%) in two groups. A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group. The control group received equal amounts of attention time. The active intervention was performed for the first 6 months, followed by a “no-contact” period. Outcome measures included A1C, Tinetti test, 6-min walk test (6MWT), self-care frequency, and diabetes-related distress. RESULTS: We assessed 100 patients (age 75 ± 5 years, duration 21 ± 13 years, 68% type 2 diabetes, 89% on insulin) over 12 months. After the active period, A1C decreased by −0.45% in the intervention group vs. −0.31% in the control group. At 12 months, A1C decreased further in the intervention group by −0.21% vs. 0% in control group (linear mixed-model, P < 0.03). The intervention group showed additional benefits in scores on measures of self-care (Self-Care Inventory-R), gait and balance (Tinetti), and endurance (6MWT) compared with the control group. Diabetes-related distress improved in both groups. CONCLUSIONS: Only attention between clinic visits lowers diabetes-related distress in older adults. However, communication with an educator cognizant of patients’ barriers improves glycemic control and self-care frequency, maintains functionality, and lowers distress in this population.
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Missed insulin injections impact HbA1c levels and lead to an increased risk of diabetes-related complications.
“The impact of missed insulin injections on HbA1c levels is well established,7–12 leading to an increasing risk of diabetes-related complications.13,14”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [8]
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Backgroundİnkaya, B. V., YILMAZER, T., Tüzer, H., & Erbil, E. Y. (2022) · Turkish Journal of Diabetes and Obesity · doi:10.25048/tudod.1149785 · Cited by 1 · see citing works
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“These care partners can provide supervision and assistance for diabetes management tasks(Baig et al., 2015; Kirkman et al., 2012; Munshi et al., 2013; Pamungkas et al., 2017) as well as emotional support (Pamungkas & Chamroonsawasdi, 2020).”
BackgroundBarriers to the Prevention and Treatment of Geriatric Diabetes.
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Diabetes Management in the United States
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- Authors
- Munshi, M. N., Segal, A. R., Suhl, E., Ryan, C., Sternthal, A., Giusti, J., Lee, Y., Fitzgerald, S., Staum, E., Bonsignor, P., DesRochers, L., McCartney, R., & Weinger, K.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Munshi, Medha N.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-02-13
- Volume
- 36
- Issue
- 3
- Pages
- 543-549
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3579376
- OpenAlex
- W2132899474
- Cited by
- 71
- References
- 23
- Citations by year
- 2026: 5 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 10 · 2018: 3 · 2017: 9 · 2016: 6 · 2015: 6 · 2014: 6 · 2013: 1
- FWCI
- 3.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- diabetes management, older adults, barriers to self-care, glycemic control, HbA1c, diabetes self-care, diabetes distress, functional capacity, gait and balance, endurance, type 2 diabetes, insulin therapy
- MeSH terms
- Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Self Care, Disease Management
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