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Cited by 45Chronic Disease Management StrategiesDiabetes Treatment and ManagementDiabetes Management and Education

Classification of Older Adults Who Have Diabetes by Comorbid Conditions, United States, 2005–2006

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Laiteerapong, N, Iveniuk, J, John, PM, Laumann, EO, Huang, ES·2012·Preventing Chronic Disease
DOI 10.5888/pcd9.110287PMC PMC3463415
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Abstract

INTRODUCTION: Older adults who have diabetes vary widely in terms of comorbid conditions; these conditions help determine the risks and benefits of intensive glycemic control. Not all people benefit from intensive glycemic control. The objective of this study was to classify by comorbid conditions older American adults who have diabetes to identify those who are less likely to benefit from intensive glycemic control. METHODS: We used latent class analysis to identify subgroups of a nationally representative sample of community-dwelling older adults (aged 57-85 y) who have diabetes (n = 750). The subgroups were classified according to 14 comorbid conditions prevalent in the older population. Using the Akaike Information Criterion, the Bayesian Information Criterion (BIC), the sample-size adjusted BIC, and the χ(2) goodness-of-fit statistic, we assessed model fit. RESULTS: We found 3 distinct subgroups. Class 1 (63% of the sample) had the lowest probabilities for most conditions. Class 2 (29% of the sample) had the highest probabilities of cancer, incontinence, and kidney disease. Class 3 (9% of the sample) had the highest probabilities (>90%) of congestive heart failure and myocardial infarction. Class 1 had only 0, 1, or 2 comorbid conditions, and both class 2 and class 3 had 6 or more comorbid conditions. The 5-year death rates for class 2 (17%) and class 3 (33%) were higher than the rate for class 1 (9%). CONCLUSION: Older adults who have diabetes, cardiovascular disease, and 6 or more comorbid conditions may represent a subgroup of older adults who are less likely to benefit from intensive glycemic control.

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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 [9]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

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  • 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 [9]

    The Results, under “Class characteristics” (page not provided), report that class 2 had the highest estimated probabilities of obesity, hypertension, and incontinence, while class 3 had the highest probabilities of myocardial infarction, congestive heart failure, and stroke. The exception is arthritis: the paper places its highest estimated probability in class 3, not class 2. (LLM, conf=0.91)

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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 [9]

    The Results (Class characteristics; page not provided) identify class 1 as relatively healthy and report that class 3 had the highest 5-year death rate (33%, versus 9% for class 1). Class 3 also had more functional difficulty, but the paper does not measure frailty or establish that it had the highest risk of frailty. The reported death rate supports the mortality comparison, not a claim that frailty led to mortality. (LLM, conf=0.86)

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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: Standards of Care in Diabetes—2026 (2026) · cites this paper as [14]

    The Results (Class characteristics; page unavailable) identify class 3 as the group with the highest probabilities of heart failure and myocardial infarction and report a 5-year death rate of 33%, versus 9% in the relatively healthy class 1. Class 3 also had more difficulty walking, but the paper does not report a measured risk of frailty, so that part of the claim is unsupported. (LLM, conf=0.88)

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  • 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 [14]

    The Discussion (page unavailable) reports three comorbidity-based classes of older adults with diabetes: a relatively healthy class and two sicker classes. The Results, under “Class characteristics” (page unavailable), support describing class 3 as cardiovascular, but characterize class 2 chiefly by cancer, incontinence, kidney disease, hypertension, and obesity; they do not clearly establish it as a distinct “geriatric” class. (LLM, conf=0.80)

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Cites

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Research works printed but not linked: 1

  1. [7]Collins LM, Lanza ST. Latent class and latent transition analysis for the social, behavioral, and health sciences. New York (NY): Wiley; 2009.

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Authors
Laiteerapong, N., Iveniuk, J., John, P., Laumann, E., & Huang, E.
Affiliations
University of Chicago (US)
Corresponding author
Laiteerapong, N
ORCID
Venue
Preventing Chronic Disease
Publisher
Centers for Disease Control and Prevention - Preventing Chronic Disease
Published
2012-05
Volume
9
Pages
E100-E100
ISSN
1545-1151 (ISSN-L)
DOI
10.5888/pcd9.110287
PMC
PMC3463415
OpenAlex
W2036585878
Cited by
44
References
25
Citations by year
2026: 2 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 7 · 2014: 3 · 2012: 2
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Preventing Chronic Disease (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (P60 DK20595)
  • National Institute on Aging (R01 AG17872-01, R01AG017872)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P60DK20595, F32DK089973, P60DK020595, P30DK092949)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes mellitus, older adults, comorbidities, tight glycemic control, latent class analysis, subgroups, congestive heart failure, myocardial infarction, cancer, kidney disease, incontinence, mortality, cardiovascular disease
MeSH terms
Aged, Aging, Chronic Disease, Diabetes Mellitus, Humans, Middle Aged, United States

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