Identifying Effective Treatment Strategies for Older Adults with Diabetes

描述（由申请人提供）：确定老年糖尿病患者的有效治疗策略。糖尿病患病率随着年龄的增长而增加，影响45-60岁美国人口的10.6%，65-74岁人口的19.1%，75岁及以上人口的17.6%。尽管如此，糖尿病的临床研究主要是在年轻受试者中进行的，指南也是从年轻受试者中得出的。老年糖尿病患者是一个生理和社会人口学异质性人群。最近在糖尿病和心血管疾病受试者中进行的强化血糖控制的大型临床试验表明，老年人在推荐的糖尿病治疗中可能会遇到更大的问题。目前老年人群糖尿病护理指南主要来自缺乏临床数据的专家意见和共识。拟议工作的目的是启动老年人糖尿病最佳管理的研究，重点是研究创新的治疗靶点，改善糖尿病沿着生活质量和整体健康，并确定那些最有可能受益的人。重要的未被认识到的治疗目标包括抑郁情绪，不活动和睡眠障碍。这项工作的预期成果将是：（1）确定这些问题的发生率和治疗相关性，在一个具有全国代表性的社区居住的老年糖尿病患者的概率样本;和（2）开发和分析一个纵向队列，以确定糖尿病进展的轨迹，心血管疾病进展，和老年糖尿病患者的死亡。这些目标是将临床实践的重点从狭窄的代谢措施转移到更广泛地考虑生活质量和整体健康的先决条件。从该项目中吸取的经验教训将用于支持进一步的工作，以开发和测试一种广泛适用的多因素干预措施，该措施针对传统医疗背景下的非传统治疗目标，以改善老年糖尿病患者的生活质量和整体健康状况。最终目标将是改善这一重要、普遍和不断扩大的人口的护理指南和整体有效性。 公共卫生相关性：2型糖尿病的流行主要影响老年人，但治疗建议是基于在年轻人群中进行的研究。最近在糖尿病和心血管疾病受试者中进行的强化血糖控制的大型临床试验表明，老年人在推荐的糖尿病治疗中可能会遇到更大的问题。该项目的目标是调查治疗目标，将改善糖尿病以及生活质量和整体健康，并确定哪些老年糖尿病患者将受益于治疗。

DESCRIPTION (provided by applicant): Identifying Effective Treatment Strategies for Older Adults with Diabetes. Diabetes prevalence increases with age, affecting 10.6% of the U.S. population 45-60 years of age, 19.1% of those 65-74 years, and 17.6% of those 75 and older. Nonetheless, clinical research in diabetes has been primarily conducted in, and guidelines have been derived from, younger subjects. Older patients with diabetes represent a physiologically and sociodemographically heterogeneous population. Recent large clinical trials of intensive glycemic control in subjects with diabetes and cardiovascular disease suggest that older people may experience greater problems with recommended diabetes treatments. Current guidelines for care of diabetes in the geriatric population are largely derived from expert opinion and consensus in the absence of clinical data. The purpose of the proposed work is to initiate research in optimal management of diabetes in the older adults, with emphases on investigation of innovative therapeutic targets that improve diabetes along with quality of life and overall health and identification those who are most likely to derive benefit. Important underrecognized treatment targets include depressed mood, inactivity, and sleep disorders. The expected outcomes of this work will be to: (1) determine the rates and treatment correlates of these problems in a nationally representative probability sample of community-dwelling older adults with diabetes; and (2) develop and analyze a longitudinal cohort to determine trajectories of diabetes progression, cardiovascular disease progression, and death in older adults with diabetes. These goals are prerequisites for shifting the focus of clinical practice from narrow metabolic measures to a broader consideration of contributors to quality of life and overall health. Lessons learned from this project will be used to support further work to develop and test a widely applicable, multifactorial intervention targeting non-traditional treatment targets in the context of traditional medical care to achieve improved glycemia, quality of life, and overall health outcomes in older adults with diabetes. The ultimate goal will be to improve guidelines and overall effectiveness of care for this important, prevalent, and expanding population. PUBLIC HEALTH RELEVANCE: The epidemic of type 2 diabetes mostly affects older people, but treatment recommendations are based on research conducted in younger populations. Recent large clinical trials of intensive glycemic control in subjects with diabetes and cardiovascular disease suggest that older people may experience greater problems with recommended diabetes treatments. The goals of this project are to investigate treatment targets that will improve diabetes as well as quality of life and overall health and determine which older people with diabetes will benefit from treatment.