Most diabetes care guidelines are based on research with middle-aged patients and focus on blood pressure, cholesterol, and glycemic control. However, the care and treatment of older adults with diabetes is more complex. These individuals are at increased risk for geriatric syndromes, such as depression and falls, as well as hypoglycemia (low blood sugar) resulting from drugs they are taking.
A new study reveals that geriatric syndromes and hypoglycemia are associated with lower health-related quality of life (HRQL) as much as diabetes complications. The study included 6,317 adults aged 60 to 75 years with type 1 or type 2 diabetes, who were enrolled in a large health maintenance organization in northern California. Each participant completed a health survey asking questions about their physical functioning, role limitations, pain levels, social functioning, and mental health. The researchers also used medical records to identify geriatric syndrome diagnoses, diabetes complications, and hypoglycemic events. Any geriatric syndrome or diabetes complication, as well as hypoglycemia, were all associated with lower physical HRQL. The most significant problem was amputation, followed by congestive heart failure (CHF), falls, chronic pain, and heart attack.
No association was found between significantly lower mental HRQL and having a geriatric syndrome or diabetes complication in general. However, some conditions, such as depression and being underweight, resulted in lower mental HRQL. Amputation, CHF, falls, chronic pain, heart attack, depression, underweight, and hypoglycemia were more strongly associated with lower HRQL than diabetes-related factors, such as duration of diabetes and insulin use. The study was supported in part by the Agency for Healthcare Research and Quality (HS00084).
See "Correlates of quality of life in older adults with diabetes: the diabetes & aging study," by Neda Laiteerapong, M.D., Andrew J. Karter, Ph.D., Jennifer Y. Liu, M.P.H., and others, in the Diabetes Care 34(8), pp. 1749-1753, 2011.