Division of Geriatrics, Department of Internal Medicine, University of Michigan and Veterans Administration Health Center, 300 N. Ingalls St., Ann Arbor, MI 48109, USA.
Med Care. 2010 Apr;48(4):327-34. doi: 10.1097/mlr.0b013e3181ca4035.
Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.
To investigate how many older and middle-aged adults with diabetes have such health status characteristics.
Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.
SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).
Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.
Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.).
Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.
一些糖尿病患者可能具有健康状况特征，这些特征可能使糖尿病自我管理（DSM）变得困难，并导致血糖控制不佳，或限制某些糖尿病管理干预措施的获益。
调查有多少中老年糖尿病患者具有这种健康状况特征。
对一项具有全国代表性的健康访谈调查——健康与退休研究及其糖尿病邮寄调查的二次数据分析。
地点/参与者：年龄在 51 岁及以上且患有糖尿病的美国人（n=3506，代表 1360 万人）；糖尿病邮寄调查中年龄在 56 岁及以上的患者（n=1132，代表 990 万人）。
患有糖尿病的成年人数量，以及（a）健康状况相对较好的人数；（b）可能使 DSM 变得困难的健康状况人数（例如合并症、工具性日常生活活动受损）；（c）可能限制某些糖尿病管理获益的特征人数，如晚期痴呆和日常生活活动依赖。健康与退休研究的测量指标包括人口统计学因素。糖尿病邮寄调查包括自我测量的糖化血红蛋白。
近 22%的年龄≥51 岁的糖尿病患者（约 300 万人）具有可能使 DSM 变得困难的健康特征。另有 10%（140 万人）可能从某些糖尿病管理中获益有限。具有可能使 DSM 变得困难的健康特征的邮寄调查受访者的平均糖化血红蛋白显著高于健康状况相对较好的受访者（7.6%比 7.3%，P<0.04）。
一些中年和老年糖尿病患者具有可能使 DSM 变得困难或获益有限的健康状况特征。目前的糖尿病质量衡量指标，包括血糖控制指标，可能无法反映所有患者群体的可能性或最佳情况。
