Improving the American Diabetes Association Framework for individualizing treatment in older adults: evaluating life expectancy.
Improving the American Diabetes Association Framework for individualizing treatment in older adults: evaluating life expectancy.
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DOI：
10.1136/bmjdrc-2020-001624
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发表时间：
2020-09
影响因子：
4.1
通讯作者：
Lee SJ
中科院分区：
文献类型：
--
作者：
Lee AK;Steinman MA;Lee SJ
对于患有2型糖尿病的老年人，美国糖尿病协会（ADA）框架使用合并症和功能状态根据估计的预期寿命对患者进行分类，以指导血糖治疗的个体化。我们评估了通过删除三种合并症并纳入年龄来修改ADA框架是否可以改善预期寿命分层，并更好地识别可能从强化治疗中获益的患者。我们研究了1998年至2004年期间3166名年龄≥65岁的糖尿病健康与退休研究参与者，采用前瞻性队列设计，死亡率随访至2016年。我们将参与者分为三个ADA框架类别之一：健康，中等健康和健康状况不佳。我们通过排除与死亡率弱相关的合并症（高血压、关节炎和尿失禁）创建了修改后的类别。使用Gompertz回归，我们估计了原始和修改的ADA框架类别的各年龄层的预期寿命。最初的ADA框架将34%的人归类为健康（可能从强化治疗中获益），50%为中等健康，16%为健康状况不佳（不太可能从强化治疗中获益）。我们的共同体修正将20%的参与者从中级健康重新分类为健康。使用修改的ADA框架，健康人群的中位预期寿命因年龄而异（65-69岁：16.3岁; ≥80岁：7.6岁），表明获益的可能性不同。此外，年龄≥80岁不太可能延长预期寿命（健康人群的中位预期寿命为7.6年，中等健康人群为5.9年，较差健康人群为2.5年），表明≥80岁的成人不太可能从强化治疗中获益。通过纳入年龄和关注与死亡率相关的合并症来修改ADA框架，改善了预期寿命分层，从而为许多老年人提供了不同的治疗建议。
For older adults with type 2 diabetes, the American Diabetes Association (ADA) Framework uses comorbidities and functional status to categorize patients by estimated life expectancy to guide individualization of glycemic treatment. We evaluated whether modifying the ADA Framework by removing three comorbidities and incorporating age could improve life expectancy stratification and better identify patients likely to benefit from intensive treatment. We examined 3166 Health and Retirement Study participants aged ≥65 with diabetes from 1998 to 2004, using a prospective cohort design with mortality follow-up through 2016. We classified participants into one of three ADA Framework categories: Healthy, Intermediate Health, and Poor Health. We created modified categories by excluding comorbidities weakly associated with mortality (hypertension, arthritis, and incontinence). Using Gompertz regression, we estimated life expectancy across age strata for both original and modified ADA Framework categories. The original ADA Framework classified 34% as Healthy (likely to benefit from intensive treatment), 50% as Intermediate Health, and 16% as Poor Health (unlikely to benefit from intensive treatment). Our comorbidity modification reclassified 20% of participants from Intermediate Health to Healthy. Using the modified ADA Framework, median life expectancy of the Healthy varied greatly by age (aged 65–69: 16.3 years; aged ≥80: 7.6 years), indicating differing likelihood of benefit. Additionally, age ≥80 made extended life expectancy unlikely (median life expectancy for Healthy 7.6 years, Intermediate Health 5.9 years, Poor Health 2.5 years), suggesting adults ≥80 are unlikely to benefit from intensive treatment. Modifying the ADA Framework by incorporating age and focusing on comorbidities associated with mortality improved life expectancy stratification, resulting in different treatment recommendations for many older adults.
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影响因子：
3.7
作者：
Lee SJ;Boscardin WJ;Kirby KA;Covinsky KE
通讯作者：
Covinsky KE
DOI：
10.1001/jama.2016.0299
发表时间：
2016-03-08
期刊：
JAMA
影响因子：
--
作者：
Lipska KJ;Krumholz H;Soones T;Lee SJ
通讯作者：
Lee SJ
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
5.5
作者：
Laiteerapong, Neda;Iveniuk, James;Huang, Elbert S.
通讯作者：
Huang, Elbert S.