The DOI matches its Crossref record; 56 of the 57 references it cites were found in a registry or an index.
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
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“individuals with shorter life expectancy, advanced diabetes complications, life-limiting comorbid illnesses, frailty, or substantial cognitive or functional impairments will have less benefit from glucose lowering”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [72]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Based on concepts of competing mortality and time to benefit, some people in this category with shorter life expectancy will have less benefit from glucose lowering and should have less stringent glycemic goals (64).”
From 13. Older Adults: Standards of Care in Diabetes—2024 (2024) · cites this paper as [64]
The cited source says what the claim attributes to it.
In the citing paper
“Based on concepts of competing mortality and time to benefit, some people in this category with shorter life expectancy will have less benefit from glucose lowering and should have less stringent glycemic goals (66).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [66]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742
(1993) · New England Journal of Medicine · doi:10.1056/nejm199309303291401 · Cited by 24,667
Prediction of coronary heart disease using risk factor categories
Wilson, P. W. F., D’Agostino, R. B., Levy, D., Belanger, A. M., Silbershatz, H., & Kannel, W. B. (1998) · Circulation · doi:10.1161/01.cir.97.18.1837 · Cited by 9,581
Standards of Medical Care in Diabetes
Power, D. V. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1593 · Cited by 8,676
Turner, R. C., Fox, C., Matthews, McElroy, H. H., Cull, C. A., Holman, R. R., Neil, P., Hadden, D. R., Wright, D., Manley, E., et al. (1998) · The Lancet · Cited by 8,419
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
(2005) · New England Journal of Medicine · doi:10.1056/nejmoa052187 · Cited by 5,138
Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572
Gupta, A., & Uribarri, J. (2016) · Hormone Research in Paediatrics · doi:10.1159/000444053 · Cited by 4,023
Cardiovascular disease risk profiles
Anderson, K. M., Odell, P. M., Wilson, P. W. F., & Kannel, W. B. (1991) · American Heart Journal · doi:10.1016/0002-8703(91)90861-b · Cited by 2,163
Standards of Medical Care in Diabetes–2006
American Diabetes Association (2006) · Diabetes Care · doi:10.2337/diacare.29.s1.06.s4 · Cited by 1,885
Probability of stroke: a risk profile from the Framingham Study.
Wolf, P. A., D'Agostino, R. B., Belanger, A. J., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.3.312 · Cited by 1,782
Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes
Saydah, S. H. (2004) · JAMA · doi:10.1001/jama.291.3.335 · Cited by 1,357
Standards of Medical Care in Diabetes—2007
American Diabetes Association (2007) · Diabetes Care · doi:10.2337/dc07-s004 · Cited by 1,190
The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56)
STEVENS, R. J., KOTHARI, V., ADLER, A. I., & STRATTON, I. M. (2001) · Clinical Science · doi:10.1042/cs20000335 · Cited by 1,084
The Vulnerable Elders Survey: A Tool for Identifying Vulnerable Older People in the Community
Saliba, D., Elliott, M. N., Rubenstein, L. Z., Solomon, D. H., Young, R. T., KAMBERG, C. J., Roth, C. P., MacLean, C. H., Shekelle, P., Sloss, E. M., et al. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49281.x · Cited by 1,082
Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults
Lee, S. J. (2006) · JAMA · doi:10.1001/jama.295.7.801 · Cited by 809
Standards of Medical Care in Diabetes
(2004) · Diabetes Care · doi:10.2337/diacare.27.2007.s15 · Cited by 688
Hunink, M. G. M. (1997) · JAMA · doi:10.1001/jama.277.7.535 · Cited by 674
Guidelines for improving the care of the older person with diabetes mellitus
California Healthcare Foundation/American Geriatrics Society, C. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.51.5s.1.x · Cited by 651
Clarke, P. M., Gray, A. M., Briggs, A., Farmer, A. J., Fenn, P., Stevens, R. J., Matthews, D. R., Stratton, I. M., Holman, R. R., & on behalf of the UK Prospective Diabetes Study (UKPDS) Group (2004) · Diabetologia · doi:10.1007/s00125-004-1527-z · Cited by 615
Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988–2002
SAADDINE, J. B., Cadwell, B. L., Gregg, E. W., Engelgau, M. M., Vinicor, F., Imperatore, G., & Narayan, K. M. V. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-7-200604040-00005 · Cited by 561
The CDC Diabetes Cost-effectiveness Group (2002) · JAMA · doi:10.1001/jama.287.19.2542 · Cited by 507
Kothari (2002) · doi:10.1161/01.str.0000020091.07144.c7 · Cited by 420
Survival and recurrence after first cerebral infarction
Petty, G. W., Brown, R., Whisnant, J. P., Sicks, J. D., O’Fallon, W. M., & Wiebers, D. O. (1998) · Neurology · doi:10.1212/wnl.50.1.208 · Cited by 392
United States life tables, 2003.
Arias, E. (2006) · PubMed · Cited by 376
Robbins, J. M., Vaccarino, V., Zhang, H., & Kasl, S. V. (2001) · American Journal of Public Health · doi:10.2105/ajph.91.1.76 · Cited by 368
Recovery From Disability Among Community-Dwelling Older Persons
Hardy, S. E. (2004) · JAMA · doi:10.1001/jama.291.13.1596 · Cited by 365
Feld, S. (2002) · Endocrine Practice · doi:10.4158/ep.8.s1.40 · Cited by 359
Hypoglycemia in patients with type 2 diabetes mellitus
Miller, C. D., Phillips, L. S., Ziemer, D. C., Gallina, D. L., Cook, C. B., & El-Kebbi, I. M. (2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.13.1653 · Cited by 341
Eastman, R. C., Javitt, J. C., Herman, W. H., Dasbach, E. J., Copley‐Merriman, C., Maier, W. C., Dong, F., Manninen, D. L., Zbrozek, A. S., Kotsanos, J. G., et al. (1997) · Diabetes Care · doi:10.2337/diacare.20.5.735 · Cited by 333
Preference-Based Measures in Economic Evaluation in Health Care
Neumann, P. J., Goldie, S. J., & Weinstein, M. C. (2000) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.21.1.587 · Cited by 296
Fleming, B., Greenfield, S., Engelgau, M., Pogach, L., Clauser, S., & Parrott, M. A. (2001) · Diabetes Care · doi:10.2337/diacare.24.10.1815 · Cited by 294
Patient Perceptions of Quality of Life With Diabetes-Related Complications and Treatments
Huang, E. S., Brown, S. E. S., Ewigman, B., Foley, E. C., & Meltzer, D. O. (2007) · Diabetes Care · doi:10.2337/dc07-0499 · Cited by 288
Self-citationModel of Complications of NIDDM: I. Model construction and assumptions
Eastman, R. C., Javitt, J. C., Herman, W. H., Dasbach, E. J., Zbrozek, A. S., Dong, F., Manninen, D. L., GARFIELD, S. A., Copley‐Merriman, C., Maier, W. C., et al. (1997) · Diabetes Care · doi:10.2337/diacare.20.5.725 · Cited by 259
Computer Modeling of Diabetes and Its Complications
The Mount Hood 4 Modeling Group (2007) · Diabetes Care · doi:10.2337/dc07-9919 · Cited by 243
Tennvall, G. R., & Apelqvist, J. (2001) · Diabetologia · doi:10.1007/s001250100013 · Cited by 229
Estimated benefits of glycemic control in microvascular complications in type 2 diabetes
Vijan, S., Hofer, T. P., & Hayward, R. A. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-9-199711010-00003 · Cited by 228
Primer on Medical Decision Analysis: Part 3—Estimating Probabilities and Utilities
Naglie, G., Krahn, M. D., Naimark, D. M. J., Redelmeier, D. A., & Detsky, A. S. (1997) · Medical Decision Making · doi:10.1177/0272989x9701700203 · Cited by 221
United States life tables, 1998.
Anderson, R. N., & DeTurk, P. B. (2001) · PubMed · Cited by 214
Chronic Renal Failure in Non-Insulin-Dependent Diabetes Mellitus
Humphrey, L. L., Ballard, D., Frohnert, P. P., Chu, C.-P., O'Fallon, W. M., & Palumbo, P. J. (1989) · Annals of Internal Medicine · doi:10.7326/0003-4819-111-10-788 · Cited by 180
Huang, E. S., Meigs, J. B., & Singer, D. E. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)00978-0 · Cited by 163
Self-citationQaseem, A., Vijan, S. S., Snow, V. T., Cross, J. T., Weiss, K. B., & Owens, D. K. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-6-200709180-00012 · Cited by 154
Rosen, A. B., Hamel, M. B., Weinstein, M. C., Cutler, D., Fendrick, A. M., & Vijan, S. S. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-143-2-200507190-00007 · Cited by 130
Using Clinical Guidelines Designed for Older Adults With Diabetes Mellitus and Complex Health Status
Durso, S. C. (2006) · JAMA · doi:10.1001/jama.295.16.1935 · Cited by 128
Huang, E. S., Zhang, Q., Brown, S. E. S., Drum, M. L., Meltzer, D. O., & Chin, M. H. (2007) · Health Services Research · doi:10.1111/j.1475-6773.2007.00734.x · Cited by 106
Self-citationTrends in Complexity of Diabetes Care in the United States From 1991 to 2000
Grant, R. W. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1134 · Cited by 105
Redekop, K., Stolk, E. A., Kok, E. T., Lovas, K., Kaló, Z., & Busschbach, J. J. V. (2004) · Diabetes & Metabolism · doi:10.1016/s1262-3636(07)70154-4 · Cited by 93
Specialty Differences in the Care of Older Patients With Diabetes
Chin, M. H., Zhang, J., & Merrell, K. (2000) · Medical Care · doi:10.1097/00005650-200002000-00003 · Cited by 83
Self-citationStafford, R. S., Monti, V., & Ma, J. (2005) · PLoS Medicine · doi:10.1371/journal.pmed.0020353 · Cited by 67
Huang, E. S., Shook, M. E., Jin, L., Chin, M. H., & Meltzer, D. O. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1443 · Cited by 55
Self-citationChin, M. H., Su, A. W., Jin, L., & Nerney, M. P. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.10.m601 · Cited by 35
Self-citationA 74-Year-Old Woman With Diabetes
Abrahamson, M. J. (2007) · JAMA · doi:10.1001/jama.297.2.196 · Cited by 20
Intensive Glucose Control in Elderly Adults
Hayward, R. A., Hofer, T. P., & Vijan, S. S. (2007) · JAMA · doi:10.1001/jama.297.20.2195-a · Cited by 3
Research works printed but not linked: 4
- 10.2337/diacare.28.suppl_1.S4 · DOI · Paper page
- 10.1001/jama.1997.03540310033031 · DOI
- Dasbach EJ, 1992, Med Decis Making, 12, 351
- Arias E, 2006, Natl Vital Stat Rep, 54, 1
Cited by
Sorted by citations
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Diabetes Care · doi:10.2337/dc12-1801 · Cited by 1,274
Self-citationCryer, P. E., Davis, S. N., & Shamoon, H. (2003) · Diabetes Care · doi:10.2337/diacare.26.6.1902 · Cited by 1,160
Prognostic Indices for Older Adults: A Systematic Review
Yourman, L. C., Lee, S. J., Schonberg, M. A., Widera, E. W., & Smith, A. K. (2012) · JAMA · doi:10.1001/jama.2011.1966 · Cited by 736
Type 2 diabetes mellitus in older adults: clinical considerations and management
Bellary, S., Kyrou, I., Brown, J. E., & Bailey, C. J. (2021) · Nature Reviews Endocrinology · doi:10.1038/s41574-021-00512-2 · Cited by 639
Metadata
- Authors
- Huang, E. S., Zhang, Q., Gandra, N., Chin, M. H., & Meltzer, D. O.
- Affiliations
- Boston University (US)
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
