Cited by 165Diabetes Treatment and ManagementDiabetes Management and ResearchChronic Disease Management Strategies

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The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis

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Huang, Elbert S., Zhang, Qi, Gandra, Niren, Chin, Marshall H., Meltzer, David O.·2008·Annals of Internal Medicine

DOI 10.7326/0003-4819-149-1-200807010-00005PMC PMC2562733

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Abstract

BACKGROUND: Physicians are uncertain about when to pursue intensive glucose control among older patients with diabetes. OBJECTIVE: To assess the effect of comorbid illnesses and functional status, mediated through background mortality, on the expected benefits of intensive glucose control. DESIGN: Decision analysis. DATA SOURCES: Major clinical studies in diabetes and geriatrics. TARGET POPULATION: Patients 60 to 80 years of age who have type 2 diabetes and varied life expectancies estimated from a mortality index that was validated at the population level. TIME HORIZON: Patient lifetime. PERSPECTIVE: Health care system. INTERVENTION: Intensive glucose control (hemoglobin A1c [HbA1c] level of 7.0) versus moderate glucose control (HbA1c level of 7.9). OUTCOME MEASURES: Lifetime differences in incidence of complications and average quality-adjusted days. RESULTS OF BASE-CASE ANALYSIS: Healthy older patients of different age groups had expected benefits of intensive glucose control ranging from 51 to 116 quality-adjusted days. Within each age group, the expected benefits of intensive control steadily declined as the level of comorbid illness and functional impairment increased (mortality index score, 1 to 26 points). For patients 60 to 64 years of age with new-onset diabetes, the benefits declined from 106 days at baseline good health (life expectancy, 14.6 years) to 44 days with 3 additional index points (life expectancy, 9.7 years) and 8 days with 7 additional index points (life expectancy, 4.8 years). A similar decline in benefits occurred among patients with prolonged duration of diabetes. RESULTS OF SENSITIVITY ANALYSIS: With alternative model assumptions (such as Framingham models), expected benefits of intensive control declined as mortality index scores increased. LIMITATIONS: Diabetes clinical trial data were lacking for frail, older patients. The mortality index was not validated for use in predicting individual-level life expectancies. Adverse effects of intensive control were not taken into account. CONCLUSION: Among older diabetic patients, the presence of multiple comorbid illnesses or functional impairments is a more important predictor of limited life expectancy and diminishing expected benefits of intensive glucose control than is age alone.

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Authors: Huang, E. S., Zhang, Q., Gandra, N., Chin, M. H., & Meltzer, D. O.
Affiliations: Boston University (US)
ORCID: Huang, Elbert S.
Zhang, Qi
Chin, Marshall H.
Meltzer, David O.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2008-07-01
Volume: 149
Issue: 1
Pages: 11-19
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-149-1-200807010-00005
PMC: PMC2562733
OpenAlex: W2144693872
Cited by: 165
References: 57
Citations by year: 2026: 3 · 2025: 7 · 2024: 9 · 2023: 10 · 2022: 7 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 6 · 2017: 11 · 2016: 13 · 2015: 9 · 2014: 10 · 2013: 11 · 2012: 14
FWCI: 9.68
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (K23AG021963)
National Institute of Diabetes and Digestive and Kidney Diseases (P60DK20595, K24DK071933, P60DK020595)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD056073)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords: type 2 diabetes, older adults, tight glycemic control, glycemic control, comorbidities, functional status, mortality index, life expectancy, diabetes complications, HbA1c, frailty, decision analysis
MeSH terms: Aged, Aged, 80 and over, Blood Glucose, Decision Support Techniques, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Life Expectancy, Male, Middle Aged, Quality of Life, Sensitivity and Specificity, Diabetes Complications

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The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis

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