Older Adults Reporting More Diabetes Mellitus Care Have Greater 9‐Year Survival

Abstract

Objectives Delivery of recommended diabetes care processes has improved nationally but it is unclear if there is any association with improved survival in middle-aged and older adults with diabetes. We hypothesized that receiving more recommended diabetes care processes would translate into better 9-year survival for people in these age groups. Design We studied the 9-year (2002–11) mortality of adults aged ≥51 years with self-reported diabetes using the Health and Retirement Study Diabetes Mailout Survey (n=1,879). We dichotomized a composite measure of 5 self-reported diabetes care process measures defined as greater (3–5 processes) versus fewer (0–2 processes) care processes provided. Setting Health and Retirement Study (HRS). Participants Respondents aged ≥51 years (n=1,879) with self-reported diabetes who completed both the Diabetes Mailout Survey and the core 2002 HRS survey. Measurements Cox Proportional Hazards model to test relationships between reported measures and mortality, controlling for socio-demographics, function, comorbidities, geriatric conditions, and insulin use. Results Baseline mean age was 68.8 (± 8.7) with 26.5% ≥75 years. Prevalence of each self-reported care process was 80.1%, 75.9%, 67.5%, 67.7%, and 48.2% for glycosylated hemoglobin testing, urine test, eye exam, aspirin counseling, and diabetes education, respectively. In 9 years, 32.1% respondents died. Greater care correlated with 24% less risk of dying (adjusted hazard ratio [aHR] = 0.76, 0.64–0.91). When respondents were age-stratified (≥ versus <75 years) improved survival was statistically significant only in the older age group. Conclusion While we are unable to account for differences in adherence to care that may also affect survival, our study demonstrates that monitoring and counseling types of diabetes care processes are associated with long-term survival benefit even among older adults aged ≥75 with diabetes.

Are Two Heads Better Than One or Do Too Many Cooks Spoil the Broth? The Trade‐Off between Physician Division of Labor and Patient Continuity of Care for Older Adults with Complex Chronic Conditions

“…The same disease-relevant specialist involvement that is associated with delivery of guideline-concordant care and improved patient outcomes also increases resource use for care processes typically performed in an officebased setting. This relationship between better patient health outcomes and resource use has been found elsewhere-most recently for heart attack patients due to more intensive physician care (Currie, MacLeod, and Van Parys 2016) and for older adults with diabetes due to greater use of recommended care processes (Han et al 2015). Although it is plausible that an increase in prior year care processes due to specialist involvement could lead to higher incidence of following year hospital and ED use due to more frequent interaction with the health care system, it is also plausible that an increase in prior year care processes could lead to prevention of disease complications and reduced likelihood of following year acute events.…”

Adherence to Guidelines for Screening and Medication Use: Mortality and Onset of Major Macrovascular Complications in Elderly Persons With Diabetes Mellitus

“…Han, Blaum, Ferris, Min, and Lee (2015) based their measure of adherence on a composite of five self-reported DM care process measures divided into two groups—three to five processes followed versus zero to two processes followed. Holding other factors constant, those respondents adhering to three to five processes experienced a 24% lower risk of dying during the 9-year follow-up period than did those who adhered to zero to two care processes.…”

“…Chen et al’s results for medication adherence were far weaker than in the present study. Similar to Han et al (2015), this is likely due to the limited statistical power of the dataset and reliance on self-reported adherence to medication use measured at one point in time.…”

Racial and Regional Disparities in Outcomes Among Veterans Initially Adherent to Oral Antidiabetic Therapies: an Observational Cohort Study

“…In analyses ranging from 3 to 9 years of follow-up, being adherent has been connected with a decreased likelihood of diabetes-related outcomes, such as hypoglycemia, microvascular complications, hospitalization, and cardiovascular or cerebrovascular events. [12][13][14][15][16] Despite comparatively better outcomes by having more medication on hand (i.e., higher PDC), being adherent to antidiabetic medications is not a guarantee that undesired outcomes will be avoided. Our previous analyses comparing cardiovascular, cerebrovascular, microvascular, and all-cause mortality outcomes by medication adherence status among veterans with diabetes revealed that while many outcomes were improved by higher rates of medication use, adherence did not prevent all targeted outcomes.…”