Individualized HbA1c treatment goals for older aldults with diabetes mellitus

老年糖尿病患者的个体化 HbA1c 治疗目标

• 批准号: 271269462
• 负责人: Privatdozent Dr. Ben Schöttker
• 金额: --
• 依托单位: Universitätsklinikum Köln
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2014
• 资助国家: 德国
• 起止时间: 2013-12-31 至 2015-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/271269462?language=en
• 关键词: Individualized; HbA1c; treatment; goals; older

The current version of the German national guideline for the treatment of type 2 diabetes mellitus from the year 2013 recommends, among other things, to individualize HbA1c treatment goals by age and co-morbidity but does not state concrete reference values to be used as an orientation for care givers. Up to date, studies addressing this research question are lacking nationally and internationally. The goal of this grant application is to conduct the preparatory work to set up a consortium of ageing cohorts aiming for concrete recommendations for individualized HbA1c treatment goals in older adults with diabetes mellitus. The preparatory work can be done with already collected data from the ESTHER and DIANA cohort studies, which are conducted by the German Cancer Research Center and comprise altogether 2,466 individuals with diabetes mellitus in the age range 50-84 years. The preparatory work shall only identify a global HbA1c treatment goal for older adults with diabetes mellitus, which may be higher than the one for younger diabetics. It can be assumed that higher HbA1c treatment goals lead to less frequent hypoglycemias and a higher quality of life. An accumulation of deficits index (ADI) will be chosen as the outcome for the analyses because maintaining functional abilities is more important than preventing single diabetes co-morbidities in this age group with a limited life expectancy. Because of sample size limitations, analyses in the ESTHER and DIANA cohort cannot be conducted stratified by patient characteristics that could be useful to individualize the global HbA1c treatment goal. This shall be the objective of the consortium in a follow up project. However, the testing for effect modification by patient characteristics with respect to the association of HbA1c and changes of the ADI will already be possible and shall be done in the ESTHER and DIANA study to provide the ground for a sample size calculation for the consortium. The sample size of older adults with diabetes mellitus in the consortium shall be sufficient to estimate HbA1c reference values groups stratified by all relevant patient characteristics. The following patient characteristics will be assessed: Age, sex, education, life-style factors, co-morbidity, frailty and diabetes duration. Finally, it will be described, how often and for what reasons individualized HbA1c treatment goals are already applied in the German primary care setting and to quantify the discrepancy with the results of this project. This final investigation, which has high relevance for the care of older diabetes patients, shall estimate the demand for interventions that could result from the overall project.

自2013年起，德国国家2型糖尿病治疗指南的现行版本建议，除其他事项外，根据年龄和合并症对HbA 1c治疗目标进行个体化，但未说明用作护理人员指导的具体参考值。迄今为止，解决这一研究问题的研究缺乏国内和国际。这项拨款申请的目标是进行准备工作，以建立一个老龄队列联盟，旨在为老年糖尿病患者的个性化HbA 1c治疗目标提供具体建议。准备工作可以利用已经从ESTHER和DIANA队列研究中收集的数据进行，这些研究由德国癌症研究中心进行，共包括2，466名年龄在50-84岁之间的糖尿病患者。准备工作应仅确定老年糖尿病患者的全球HbA 1c治疗目标，该目标可能高于年轻糖尿病患者的目标。 可以假设，较高的HbA 1c治疗目标导致低血糖发生频率降低和生活质量提高。将选择缺陷累积指数（ADI）作为分析结果，因为在预期寿命有限的该年龄组中，维持功能能力比预防单一糖尿病合并症更重要。由于样本量限制，无法按患者特征分层进行ESTHER和DIANA队列分析，这些特征可能有助于个体化全球HbA 1c治疗目标。这将是联合体在后续项目中的目标。然而，已经可以通过患者特征检测HbA 1c与ADI变化之间的相关性，并应在ESTHER和DIANA研究中进行，为联合体的样本量计算提供依据。联盟中老年糖尿病患者的样本量应足以估计按所有相关患者特征分层的HbA 1c参考值组。将评估以下患者特征：年龄、性别、教育、生活方式因素、合并症、虚弱和糖尿病病程。最后，将描述个性化HbA 1c治疗目标在德国初级保健环境中应用的频率和原因，并量化与本项目结果的差异。这一最终调查与老年糖尿病患者的护理具有高度相关性，应估计整个项目可能导致的干预需求。