Top

Current Diabetes Reports

Published in:

01-08-2019 | Hypoglycemia | Diabetes Epidemiology (E Selvin and K Foti, Section Editors)

Approaches to Risk Assessment Among Older Patients With Diabetes

Authors: Scott J. Pilla, Nancy L. Schoenborn, Nisa M. Maruthur, Elbert S. Huang

Published in: Current Diabetes Reports | Issue 8/2019

Abstract

Purpose of Review

A patient’s prognosis and risk of adverse drug effects are important considerations for individualizing care of older patients with diabetes. This review summarizes the evidence for risk assessment and proposes approaches for clinicians in the context of current clinical guidelines.

Recent Findings

Diabetes guidelines vary in their recommendations for how life expectancy should be estimated and used to inform the selection of glycemic targets. Readily available prognostic tools may improve estimation of life expectancy but require validation among patients with diabetes. Treatment decisions based on prognosis are difficult for clinicians to communicate and for patients to understand. Determining hypoglycemia risk involves assessing major risk factors; models to synthesize these factors have been developed.

Summary

Applying risk assessment to individualize diabetes care is complex and currently relies heavily on clinician judgment. More research is need to validate structured approaches to risk assessment and determine how to incorporate them into patient-centered diabetes care.

•• American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S61–70. https://doi.org/10.2337/dc19-S006. ADA standards of care, section includes individualized glycemic targets. CrossRef

•• American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S90–S102. https://doi.org/10.2337/dc19-S009. ADA standards of care, section includes individualized medication selection. CrossRef

•• American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13–28. https://doi.org/10.2337/dc19-S002. ADA standards of care for older adults. CrossRef

American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020–6. https://doi.org/10.1111/jgs.12514.CrossRef

Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez Manas L, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37 Suppl 3:S27–38. https://doi.org/10.1016/S1262-3636(11)70962-4.CrossRefPubMed

•• Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline: management of type 2 diabetes mellitus. Ann Intern Med. 2017;167(9):655–63. https://doi.org/10.7326/M17-1362. Veterans Affairs diabetes guidelines. CrossRefPubMed

•• LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, et al. Treatment of diabetes in older adults: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019. https://doi.org/10.1210/jc.2019-00198. Endocrine Society diabetes guidelines for older adults. CrossRef

Hemingway H, Croft P, Perel P, Hayden JA, Abrams K, Timmis A, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ. 2013;346:e5595. https://doi.org/10.1136/bmj.e5595.CrossRefPubMedPubMedCentral

Schneider KM, O’Donnell BE, Dean D. Prevalence of multiple chronic conditions in the United States’ Medicare population. Health Qual Life Outcomes. 2009;7:82. https://doi.org/10.1186/1477-7525-7-82.CrossRefPubMedPubMedCentral

10.

Lee PG, Cigolle C, Blaum C. The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. J Am Geriatr Soc. 2009;57(3):511–6. https://doi.org/10.1111/j.1532-5415.2008.02150.x.CrossRefPubMed

11.

Ostchega Y, Harris TB, Hirsch R, Parsons VL, Kington R. The prevalence of functional limitations and disability in older persons in the US: data from the National Health and Nutrition Examination Survey III. J Am Geriatr Soc. 2000;48(9):1132–5.CrossRefPubMed

12.

Kalyani RR, Saudek CD, Brancati FL, Selvin E. Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Diabetes Care. 2010;33(5):1055–60. https://doi.org/10.2337/dc09-1597.CrossRefPubMedPubMedCentral

13.

Blaum C, Cigolle CT, Boyd C, Wolff JL, Tian Z, Langa KM, et al. Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. Med Care. 2010;48(4):327–34.CrossRefPubMedPubMedCentral

14.

Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. 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. Ann Intern Med. 2008;149(1):11–9.CrossRefPubMedPubMedCentral

15.

Smith AK, Williams BA, Lo B. Discussing overall prognosis with the very elderly. N Engl J Med. 2011;365(23):2149–51. https://doi.org/10.1056/NEJMp1109990.CrossRefPubMedPubMedCentral

16.

American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):1957–68. https://doi.org/10.1111/j.1532-5415.2012.04187.x.CrossRefPubMedCentral

17.

Petrovic M, van der Cammen T, Onder G. Adverse drug reactions in older people: detection and prevention. Drugs Aging. 2012;29(6):453–62. https://doi.org/10.2165/11631760-000000000-00000.CrossRefPubMed

18.

Lipska KJ, Ross JS, Wang Y, Inzucchi SE, Minges K, Karter AJ, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174(7):1116–24. https://doi.org/10.1001/jamainternmed.2014.1824.CrossRefPubMedPubMedCentral

19.

Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12. https://doi.org/10.1056/NEJMsa1103053.CrossRefPubMed

20.

Vijan S, Sussman JB, Yudkin JS, Hayward RA. Effect of patients’ risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern Med. 2014;174(8):1227–34. https://doi.org/10.1001/jamainternmed.2014.2894.CrossRefPubMedPubMedCentral

21.

Huang ES, Shook M, Jin L, Chin MH, Meltzer DO. The impact of patient preferences on the cost-effectiveness of intensive glucose control in older patients with new-onset diabetes. Diabetes Care. 2006;29(2):259–64.CrossRefPubMed

22.

Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010;340:b5444. https://doi.org/10.1136/bmj.b5444.CrossRefPubMedPubMedCentral

23.

Cigolle CT, Kabeto MU, Lee PG, Blaum CS. Clinical complexity and mortality in middle-aged and older adults with diabetes. J Gerontol A Biol Sci Med Sci. 2012;67(12):1313–20. https://doi.org/10.1093/gerona/gls095.CrossRefPubMedPubMedCentral

24.

•• American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S34–45. https://doi.org/10.2337/dc19-S004. ADA standards of care, section includes risk factors for hypoglycemia. CrossRef

25.

Berkowitz SA, Aragon K, Hines J, Seligman H, Lee S, Sarkar U. Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review. Health Serv Res. 2013;48(4):1299–310. https://doi.org/10.1111/1475-6773.12048.CrossRefPubMedPubMedCentral

26.

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.CrossRef

27.

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89. https://doi.org/10.1056/NEJMoa0806470.CrossRefPubMed

28.

Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59. https://doi.org/10.1056/NEJMoa0802743.CrossRef

29.

ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. https://doi.org/10.1056/NEJMoa0802987.CrossRef

30.

Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med. 2014;371(15):1392–406. https://doi.org/10.1056/NEJMoa1407963.CrossRefPubMed

31.

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39. https://doi.org/10.1056/NEJMoa0808431.CrossRefPubMed

32.

Hayward RA, Reaven PD, Wiitala WL, Bahn GD, Reda DJ, Ge L, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;372(23):2197–206. https://doi.org/10.1056/NEJMoa1414266.CrossRefPubMed

33.

Cruz-Jentoft AJ, Carpena-Ruiz M, Montero-Errasquin B, Sanchez-Castellano C, Sanchez-Garcia E. Exclusion of older adults from ongoing clinical trials about type 2 diabetes mellitus. J Am Geriatr Soc. 2013;61(5):734–8. https://doi.org/10.1111/jgs.12215.CrossRefPubMed

34.

•• Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2016;164(11)):740–51. https://doi.org/10.7326/M15-2650. Reviews the comparative effectiveness of diabetes medications. CrossRefPubMed

35.

•• Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22. https://doi.org/10.1056/NEJMoa1603827. Demonstrated cardiovascular benefit of liraglutide. CrossRefPubMedPubMedCentral

36.

•• Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44. https://doi.org/10.1056/NEJMoa1607141. Demonstrated cardiovascular benefit of semaglutide. CrossRefPubMed

37.

•• Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57. https://doi.org/10.1056/NEJMoa1611925. Demonstrated cardiovascular benefit of canagliflozin. CrossRefPubMed

38.

•• Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28. https://doi.org/10.1056/NEJMoa1504720. Demonstrated cardiovascular benefit of empagliflozin. CrossRefPubMed

39.

Holmes HM, Min LC, Yee M, Varadhan R, Basran J, Dale W, et al. Rationalizing prescribing for older patients with multimorbidity: considering time to benefit. Drugs Aging. 2013;30(9):655–66. https://doi.org/10.1007/s40266-013-0095-7.CrossRefPubMedPubMedCentral

40.

Reuben DB. Medical care for the final years of life: “when you’re 83, it’s not going to be 20 years”. JAMA. 2009;302(24):2686–94. https://doi.org/10.1001/jama.2009.1871.CrossRefPubMedPubMedCentral

41.

Higginson IJ, Costantini M. Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study. BMC Palliat Care. 2002;1(1):1.CrossRefPubMedPubMedCentral

42.

Kong DF, Lee KL, Harrell FE Jr, Boswick JM, Mark DB, Hlatky MA, et al. Clinical experience and predicting survival in coronary disease. Arch Intern Med. 1989;149(5):1177–81.CrossRefPubMed

43.

Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469–72.CrossRefPubMedPubMedCentral

44.

Vigano A, Dorgan M, Bruera E, Suarez-Almazor ME. The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer. 1999;86(1):170–6.CrossRefPubMed

45.

Maltoni M, Amadori D. Prognosis in advanced cancer. Hematol Oncol Clin North Am. 2002;16(3):715–29.CrossRefPubMed

46.

Warraich HJ, Allen LA, Mukamal KJ, Ship A, Kociol RD. Accuracy of physician prognosis in heart failure and lung cancer: comparison between physician estimates and model predicted survival. Palliat Med. 2016;30(7):684–9. https://doi.org/10.1177/0269216315626048.CrossRefPubMed

47.

Porensky EK, Carpenter BD. Breaking bad news: effects of forecasting diagnosis and framing prognosis. Patient Educ Couns. 2016;99(1):68–76. https://doi.org/10.1016/j.pec.2015.07.022.CrossRefPubMed

48.

Arias A. United States life tables, 2008. Hyattsville: Center for Health Statistics; 2012. Contract No. 3

49.

Minne L, Ludikhuize J, de Rooij SE, Abu-Hanna A. Characterizing predictive models of mortality for older adults and their validation for use in clinical practice. J Am Geriatr Soc. 2011;59(6):1110–5. https://doi.org/10.1111/j.1532-5415.2011.03411.x.CrossRefPubMed

50.

Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012;307(2):182–92. https://doi.org/10.1001/jama.2011.1966.CrossRefPubMedPubMedCentral

51.

ePrognosis. https://eprognosis.ucsf.edu/. Accessed March 16, 2019.

52.

• Schoenborn NL, Bowman TL 2nd, Cayea D, Pollack CE, Feeser S, Boyd C. Primary care practitioners’ views on incorporating long-term prognosis in the care of older adults. JAMA Intern Med. 2016;176(5):671–8. https://doi.org/10.1001/jamainternmed.2016.0670. Identified clinician barriers to applying prognosis in primary care. CrossRefPubMedPubMedCentral

53.

• O’Hanlon CE, Cooper JM, Lee SM, John P, Churpek M, Chin MH, et al. Life expectancy predictions for older diabetic patients as estimated by physicians and a prognostic model. MDM Policy Pract. 2017;2(1):2381468317713718. https://doi.org/10.1177/2381468317713718. Demonstrated that physician- and model-estimated life expectancy for patients with diabetes can complement each other. CrossRefPubMedPubMedCentral

54.

Gagne JJ, Glynn RJ, Avorn J, Levin R, Schneeweiss S. A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol. 2011;64(7):749–59. https://doi.org/10.1016/j.jclinepi.2010.10.004.CrossRefPubMedPubMedCentral

55.

Mazzaglia G, Roti L, Corsini G, Colombini A, Maciocco G, Marchionni N, et al. Screening of older community-dwelling people at risk for death and hospitalization: the Assistenza Socio-Sanitaria in Italia project. J Am Geriatr Soc. 2007;55(12):1955–60. https://doi.org/10.1111/j.1532-5415.2007.01446.x.CrossRefPubMedPubMedCentral

56.

Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med. 2004;19(10):1027–33. https://doi.org/10.1111/j.1525-1497.2004.40016.x.CrossRefPubMedPubMedCentral

57.

Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC. Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc. 2008;56(1):68–75. https://doi.org/10.1111/j.1532-5415.2007.01496.x.CrossRefPubMed

58.

Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006;295(7):801–8. https://doi.org/10.1001/jama.295.7.801.CrossRefPubMed

59.

Cruz M, Covinsky K, Widera EW, Stijacic-Cenzer I, Lee SJ. Predicting 10-year mortality for older adults. JAMA. 2013;309(9):874–6. https://doi.org/10.1001/jama.2013.1184.CrossRefPubMedPubMedCentral

60.

Lee SJ, Boscardin WJ, Kirby KA, Covinsky KE. Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality. PLoS One. 2014;9(9):e108540. https://doi.org/10.1371/journal.pone.0108540.CrossRefPubMedPubMedCentral

61.

Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. J Gen Intern Med. 2009;24(10):1115–22. https://doi.org/10.1007/s11606-009-1073-y.CrossRefPubMedPubMedCentral

62.

Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc. 2011;59(8):1444–51. https://doi.org/10.1111/j.1532-5415.2011.03523.x.CrossRefPubMedPubMedCentral

63.

•• Schonberg MA, Li V, Marcantonio ER, Davis RB, McCarthy EP. Predicting mortality up to 14 years among community-dwelling adults aged 65 and older. J Am Geriatr Soc. 2017;65(6):1310–5. https://doi.org/10.1111/jgs.14805. Extended the validation of the Schonberg mortality index to 14 years. CrossRefPubMedPubMedCentral

64.

•• Suemoto CK, Ueda P, Beltran-Sanchez H, Lebrao ML, Duarte YA, Wong R, et al. Development and validation of a 10-year mortality prediction model: meta-analysis of individual participant data from five cohorts of older adults in developed and developing countries. J Gerontol A Biol Sci Med Sci. 2017;72(3):410–6. https://doi.org/10.1093/gerona/glw166. Developed a mortality index for older adults in developing countries. CrossRefPubMed

65.

Porock D, Parker-Oliver D, Petroski GF, Rantz M. The MDS mortality risk index: the evolution of a method for predicting 6-month mortality in nursing home residents. BMC Res Notes. 2010;3:200. https://doi.org/10.1186/1756-0500-3-200.CrossRefPubMedPubMedCentral

66.

Porock D, Oliver DP, Zweig S, Rantz M, Mehr D, Madsen R, et al. Predicting death in the nursing home: development and validation of the 6-month Minimum Data Set mortality risk index. J Gerontol A Biol Sci Med Sci. 2005;60(4):491–8.CrossRefPubMed

67.

Mitchell SL, Miller SC, Teno JM, Kiely DK, Davis RB, Shaffer ML. Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. JAMA. 2010;304(17):1929–35. https://doi.org/10.1001/jama.2010.1572.CrossRefPubMedPubMedCentral

68.

Mitchell SL, Miller SC, Teno JM, Davis RB, Shaffer ML. The advanced dementia prognostic tool: a risk score to estimate survival in nursing home residents with advanced dementia. J Pain Symptom Manag. 2010;40(5):639–51. https://doi.org/10.1016/j.jpainsymman.2010.02.014.CrossRef

69.

Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc. 2003;51(2):213–21.CrossRefPubMed

70.

Kruse RL, Parker Oliver D, Mehr DR, Petroski GF, Swenson DL, Zweig SC. Using mortality risk scores for long-term prognosis of nursing home residents: caution is recommended. J Gerontol A Biol Sci Med Sci. 2010;65(11):1235–41. https://doi.org/10.1093/gerona/glq120.CrossRefPubMed

71.

•• Karter AJ, Warton EM, Lipska KJ, Ralston JD, Moffet HH, Jackson GG, et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med. 2017;177(10):1461–70. https://doi.org/10.1001/jamainternmed.2017.3844. Developed and validated a hypoglycemia risk prediction tool using health systems data. CrossRefPubMedPubMedCentral

72.

• Karter AJ, Warton EM, Moffet HH, Ralston JD, Huang ES, Miller DR, et al. Revalidation of the hypoglycemia risk stratification tool using ICD-10 codes. Diabetes Care. 2019. https://doi.org/10.2337/dc18-2154. Revalidation using ICD-10 codes. CrossRefPubMedPubMedCentral

73.

•• Chow LS, Zmora R, Ma S, Seaquist ER, Schreiner PJ. Development of a model to predict 5-year risk of severe hypoglycemia in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2018;6(1):e000527. https://doi.org/10.1136/bmjdrc-2018-000527. Developed and validated a hypoglycemia risk prediction tool using clinical data. CrossRefPubMedPubMedCentral

74.

•• Schroeder EB, Xu S, Goodrich GK, Nichols GA, O’Connor PJ, Steiner JF. Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: development and external validation of a prediction model. J Diabetes Complications. 2017;31(7):1158–63. https://doi.org/10.1016/j.jdiacomp.2017.04.004. Developed and validated a hypoglycemia risk prediction tool using health systems data. CrossRefPubMedPubMedCentral

75.

Palmer AJ, Mount Hood 5 Modeling G, Clarke P, Gray A, Leal J, Lloyd A, et al. Computer modeling of diabetes and its complications: a report on the Fifth Mount Hood challenge meeting. Value Health. 2013;16(4):670–85. https://doi.org/10.1016/j.jval.2013.01.002.CrossRefPubMed

76.

van Dieren S, Beulens JW, Kengne AP, Peelen LM, Rutten GE, Woodward M, et al. Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: a systematic review. Heart. 2012;98(5):360–9. https://doi.org/10.1136/heartjnl-2011-300734.CrossRefPubMed

77.

Schlessinger L, Eddy DM. Archimedes: a new model for simulating health care systems--the mathematical formulation. J Biomed Inform. 2002;35(1):37–50.CrossRefPubMed

78.

Eddy DM, Schlessinger L. Archimedes: a trial-validated model of diabetes. Diabetes Care. 2003;26(11):3093–101.CrossRefPubMed

79.

Eddy DM, Schlessinger L. Validation of the Archimedes diabetes model. Diabetes Care. 2003;26(11):3102–10.CrossRefPubMed

80.

Stern M, Williams K, Eddy D, Kahn R. Validation of prediction of diabetes by the Archimedes model and comparison with other predicting models. Diabetes Care. 2008;31(8):1670–1. https://doi.org/10.2337/dc08-0521.CrossRefPubMedPubMedCentral

81.

Saver BG, Hargraves JL, Mazor KM. Are population-based diabetes models useful for individual risk estimation? J Am Board Fam Med. 2011;24(4):399–406. https://doi.org/10.3122/jabfm.2011.04.110029.CrossRefPubMed

82.

Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjornsdottir S, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720–32. https://doi.org/10.1056/NEJMoa1504347.CrossRefPubMed

83.

Rawshani A, Rawshani A, Franzen S, Sattar N, Eliasson B, Svensson AM, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379(7):633–44. https://doi.org/10.1056/NEJMoa1800256.CrossRefPubMed

84.

Fried TR, Tinetti ME, Towle V, O’Leary JR, Iannone L. Effects of benefits and harms on older persons’ willingness to take medication for primary cardiovascular prevention. Arch Intern Med. 2011;171(10):923–8. https://doi.org/10.1001/archinternmed.2011.32.CrossRefPubMedPubMedCentral

85.

Fried TR, McGraw S, Agostini JV, Tinetti ME. Views of older persons with multiple morbidities on competing outcomes and clinical decision-making. J Am Geriatr Soc. 2008;56(10):1839–44. https://doi.org/10.1111/j.1532-5415.2008.01923.x.CrossRefPubMedPubMedCentral

86.

Fried TR, Bradley EH, O’Leary J. Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc. 2003;51(10):1398–403.CrossRefPubMed

87.

Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410–8. https://doi.org/10.1056/NEJMoa1003795.CrossRefPubMed

88.

Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, et al. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab. 2013;15(4):335–41. https://doi.org/10.1111/dom.12031.CrossRefPubMed

89.

Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565–72. https://doi.org/10.1001/jama.2009.460.CrossRefPubMedPubMedCentral

90.

McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35(9):1897–901. https://doi.org/10.2337/dc11-2054.CrossRefPubMedPubMedCentral

91.

Laiteerapong N, Karter AJ, Liu JY, Moffet HH, Sudore R, Schillinger D, et al. Correlates of quality of life in older adults with diabetes: the diabetes & aging study. Diabetes Care. 2011;34(8):1749–53. https://doi.org/10.2337/dc10-2424.CrossRefPubMedPubMedCentral

92.

Nicolucci A, Pintaudi B, Rossi MC, Messina R, Dotta F, Frontoni S, et al. The social burden of hypoglycemia in the elderly. Acta Diabetol. 2015;52(4):677–85. https://doi.org/10.1007/s00592-015-0717-0.CrossRefPubMed

93.

Lipska KJ, Warton EM, Huang ES, Moffet HH, Inzucchi SE, Krumholz HM, et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: the Diabetes and Aging Study. Diabetes Care. 2013;36(11):3535–42. https://doi.org/10.2337/dc13-0610.CrossRefPubMedPubMedCentral

94.

•• Lee AK, Warren B, Lee CJ, McEvoy JW, Matsushita K, Huang ES, et al. The association of severe hypoglycemia with incident cardiovascular events and mortality in adults with type 2 diabetes. Diabetes Care. 2018;41(1):104–11. https://doi.org/10.2337/dc17-1669. Determined that severe hypoglycemia was strongly associated with cardiovascular events and mortality. CrossRefPubMed

95.

Caverly TJ, Fagerlin A, Zikmund-Fisher BJ, Kirsh S, Kullgren JT, Prenovost K, et al. Appropriate prescribing for patients with diabetes at high risk for hypoglycemia: National Survey of veterans affairs health care professionals. JAMA Intern Med. 2015;175(12):1994–6. https://doi.org/10.1001/jamainternmed.2015.5950.CrossRefPubMed

96.

Cresswell KM, Fernando B, McKinstry B, Sheikh A. Adverse drug events in the elderly. Br Med Bull. 2007;83(1):259–74. https://doi.org/10.1093/bmb/ldm016.CrossRefPubMed

97.

Peene B, D’Hooge D, Vandebrouck T, Mathieu C. Patient-reported frequency, awareness and patient-physician communication of hypoglycaemia in Belgium. Acta Clin Belg. 2014;69(6):439–45. https://doi.org/10.1179/2295333714Y.0000000050.CrossRefPubMed

98.

Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P, et al. Predictors and consequences of severe hypoglycemia in adults with diabetes - a systematic review of the evidence. Washington (DC): VA Evidence-based Synthesis Program Reports; 2012.

99.

Misra-Hebert AD, Pantalone KM, Ji X, Milinovich A, Dey T, Chagin KM, et al. Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015. Diabetes Care. 2018;41(6):1164–71. https://doi.org/10.2337/dc17-1834.CrossRefPubMed

100.

Shorr RI, Ray WA, Daugherty JR, Griffin MR. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med. 1997;157(15):1681–6.CrossRefPubMed

101.

Lee AK, Lee CJ, Huang ES, Sharrett AR, Coresh J, Selvin E. Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 2017;40(12):1661–7. https://doi.org/10.2337/dc17-0819.CrossRefPubMedPubMedCentral

102.

American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. https://doi.org/10.1111/j.1532-5415.2012.03923.x.CrossRef

103.

Chelliah A, Burge MR. Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs Aging. 2004;21(8):511–30. https://doi.org/10.2165/00002512-200421080-00003.CrossRefPubMed

104.

Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356–62. https://doi.org/10.1001/jamainternmed.2014.7345.CrossRefPubMedPubMedCentral

105.

McCoy RG, Lipska KJ, Yao X, Ross JS, Montori VM, Shah ND. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med. 2016;176(7):969–78. https://doi.org/10.1001/jamainternmed.2016.2275.CrossRefPubMedPubMedCentral

106.

Thorpe CT, Gellad WF, Good CB, Zhang S, Zhao X, Mor M, et al. Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia. Diabetes Care. 2015;38(4):588–95. https://doi.org/10.2337/dc14-0599.CrossRefPubMedPubMedCentral

107.

Tseng CL, Soroka O, Maney M, Aron DC, Pogach LM. Assessing potential glycemic overtreatment in persons at hypoglycemic risk. JAMA Intern Med. 2014;174(2):259–68. https://doi.org/10.1001/jamainternmed.2013.12963.CrossRefPubMed

108.

Thai JN, Walter LC, Eng C, Smith AK. Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc. 2013;61(2):264–9. https://doi.org/10.1111/jgs.12098.CrossRefPubMedPubMedCentral

109.

Cagle JG, McClymont KM, Thai JN, Smith AK. “If you don’t know, all of a sudden, they’re gone”: caregiver perspectives about prognostic communication for disabled elderly adults. J Am Geriatr Soc. 2016;64(6):1299–306. https://doi.org/10.1111/jgs.14137.CrossRefPubMedPubMedCentral

110.

• Schoenborn NL, Janssen EM, Boyd C, Bridges JFP, Wolff AC, Xue QL, et al. Older adults’ preferences for discussing long-term life expectancy: results from a national survey. Ann Fam Med. 2018;16(6):530–7. https://doi.org/10.1370/afm.2309. Determined that many older adults did not wish to discuss long-term life expectancy until the last 1-2 years of life. CrossRefPubMedPubMedCentral

111.

Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, et al. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manag. 2007;34(1):81–93. https://doi.org/10.1016/j.jpainsymman.2006.09.035.CrossRef

112.

Powell AA, Saini SD, Breitenstein MK, Noorbaloochi S, Cutting A, Fisher DA, et al. Rates and correlates of potentially inappropriate colorectal cancer screening in the Veterans Health Administration. J Gen Intern Med. 2015;30(6):732–41. https://doi.org/10.1007/s11606-014-3163-8.CrossRefPubMedPubMedCentral

113.

Schonberg MA, Breslau ES, Hamel MB, Bellizzi KM, McCarthy EP. Colon cancer screening in U.S. adults aged 65 and older according to life expectancy and age. J Am Geriatr Soc. 2015;63(4):750–6. https://doi.org/10.1111/jgs.13335.CrossRefPubMed

114.

Drazer MW, Prasad SM, Huo D, Schonberg MA, Dale W, Szmulewitz RZ, et al. National trends in prostate cancer screening among older American men with limited 9-year life expectancies: evidence of an increased need for shared decision making. Cancer. 2014;120(10):1491–8. https://doi.org/10.1002/cncr.28600.CrossRefPubMed

115.

Schonberg MA, Breslau ES, McCarthy EP. Targeting of mammography screening according to life expectancy in women aged 75 and older. J Am Geriatr Soc. 2013;61(3):388–95. https://doi.org/10.1111/jgs.12123.CrossRefPubMedPubMedCentral

116.

Schoenborn NL, Huang J, Sheehan OC, Wolff JL, Roth DL, Boyd CM. Influence of age, health, and function on cancer screening in older adults with limited life expectancy. J Gen Intern Med. 2019;34(1):110–7. https://doi.org/10.1007/s11606-018-4717-y.CrossRefPubMed

117.

•• Schoenborn NL, Lee K, Pollack CE, Armacost K, Dy SM, Bridges JFP, et al. Older adults’ views and communication preferences about cancer screening cessation. JAMA Intern Med. 2017;177(8):1121–8. https://doi.org/10.1001/jamainternmed.2017.1778. Clarified the views of older patients on using life expectancy to individualize cancer screening decisions. CrossRefPubMedPubMedCentral

118.

Gross CP, Fried TR, Tinetti ME, Ross JS, Genao I, Hossain S, et al. Decision-making and cancer screening: a qualitative study of older adults with multiple chronic conditions. J Geriatr Oncol. 2015;6(2):93–100. https://doi.org/10.1016/j.jgo.2014.12.001.CrossRefPubMed

119.

Lewis CL, Kistler CE, Amick HR, Watson LC, Bynum DL, Walter LC, et al. Older adults’ attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities. BMC Geriatr. 2006;6:10. https://doi.org/10.1186/1471-2318-6-10.CrossRefPubMedPubMedCentral

120.

Markovitz AA, Hofer TP, Froehlich W, Lohman SE, Caverly TJ, Sussman JB, et al. An examination of deintensification recommendations in clinical practice guidelines: stepping up or scaling back? JAMA Intern Med. 2018;178(3):414–6. https://doi.org/10.1001/jamainternmed.2017.7198.CrossRefPubMed

121.

• Maciejewski ML, Mi X, Sussman J, Greiner M, Curtis LH, Ng J, et al. Overtreatment and deintensification of diabetic therapy among Medicare beneficiaries. J Gen Intern Med. 2018;33(1):34–41. https://doi.org/10.1007/s11606-017-4167-y. Determined that deintensification of diabetes treatment is unusual in tightly controlled older adults. CrossRefPubMed

122.

Sussman JB, Kerr EA, Saini SD, Holleman RG, Klamerus ML, Min LC, et al. Rates of deintensification of blood pressure and glycemic medication treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA Intern Med. 2015;175(12):1942–9. https://doi.org/10.1001/jamainternmed.2015.5110.CrossRefPubMed

123.

• McAlister FA, Youngson E, Eurich DT. Treatment deintensification is uncommon in adults with type 2 diabetes mellitus: a retrospective cohort study. Circ Cardiovasc Qual Outcomes. 2017;10(4). doi:https://doi.org/10.1161/CIRCOUTCOMES.116.003514. Determined that deintensification of diabetes treatment is unusual in tightly controlled and frail older adults.

124.

Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14. https://doi.org/10.1111/jgs.12418.CrossRefPubMed

125.

Turner JP, Tannenbaum C. Older adults’ awareness of deprescribing: a population-based survey. J Am Geriatr Soc. 2017;65(12):2691–6. https://doi.org/10.1111/jgs.15079.CrossRefPubMedPubMedCentral

126.

Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807. https://doi.org/10.1007/s40266-013-0106-8.CrossRefPubMed

127.

• Wallis KA, Andrews A, Henderson M. Swimming against the tide: primary care physicians’ views on deprescribing in everyday practice. Ann Fam Med. 2017;15(4):341–6. https://doi.org/10.1370/afm.2094.CrossRefPubMedPubMedCentral

128.

Linsky A, Simon SR, Marcello TB, Bokhour B. Clinical provider perceptions of proactive medication discontinuation. Am J Manag Care. 2015;21(4):277–83. Identified numerous barriers to deprescribing in primary care. PubMed

129.

• Petrillo LA, Gan S, Jing B, Lang-Brown S, Boscardin WJ, Lee SJ. Hypoglycemia in hospice patients with type 2 diabetes in a national sample of nursing homes. JAMA Intern Med. 2018;178(5):713–5. https://doi.org/10.1001/jamainternmed.2017.7744. Identified substantial rates of high-risk diabetes medication use and hypoglycemia among patients on hospice. CrossRefPubMed

130.

• Huang ES, Nathan AG, Cooper JM, Lee SM, Shin N, John PM, et al. Impact and feasibility of personalized decision support for older patients with diabetes: a pilot randomized trial. Med Decis Making. 2017;37(5):611–7. https://doi.org/10.1177/0272989X16654142. A promising pilot trial of a diabetes decision support tool incorporating personalized risk prediction. CrossRefPubMed

Title: Approaches to Risk Assessment Among Older Patients With Diabetes
Authors: Scott J. Pilla
Nancy L. Schoenborn
Nisa M. Maruthur
Elbert S. Huang
Publication date: 01-08-2019
Publisher: Springer US
Keyword: Hypoglycemia
Published in: Current Diabetes Reports / Issue 8/2019
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-019-1172-z

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 8/2019

Extreme Atherosclerotic Cardiovascular Disease (ASCVD) Risk Recognition

Developmental Programming of Body Composition: Update on Evidence and Mechanisms

Advanced Technology in the Management of Diabetes: Which Comes First—Continuous Glucose Monitor or Insulin Pump?

Type 2 Diabetes: Multiple Genes, Multiple Diseases

Hurdles to Generating Human Islets in Animals via Blastocyst Complementation

GPR44 as a Target for Imaging Pancreatic Beta-Cell Mass

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage