Identifying Effective Treatment Strategies for Older Adults with Diabetes

描述(由申请人提供)：为患有糖尿病的老年人确定有效的治疗策略。糖尿病患病率随着年龄的增长而增加，影响到美国45-60岁人口的10.6%，65-74岁人口的19.1%，以及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更年轻的受试者中进行的，指南也是从年轻受试者那里得出的。老年糖尿病患者代表着生理和社会人口学上的异质性人群。最近在糖尿病和心血管疾病患者中进行的强化血糖控制的大型临床试验表明，老年人使用推荐的糖尿病治疗可能会遇到更大的问题。目前老年人群的糖尿病护理指南主要是在缺乏临床数据的情况下根据专家的意见和共识得出的。拟议工作的目的是启动老年人糖尿病最佳管理的研究，重点是调查创新的治疗目标，以改善糖尿病的生活质量和整体健康，并确定哪些人最有可能受益。重要的未被认识的治疗目标包括情绪低落、缺乏活动和睡眠障碍。这项工作的预期结果将是：(1)在具有全国代表性的社区老年糖尿病患者的概率样本中确定这些问题的发生率和治疗相关性；以及(2)开发和分析纵向队列，以确定糖尿病老年患者的糖尿病进展、心血管疾病进展和死亡的轨迹。这些目标是将临床实践的重点从狭隘的新陈代谢测量转移到对生活质量和整体健康的更广泛考虑的先决条件。从该项目中吸取的经验教训将被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，在传统医疗保健的背景下针对非传统治疗目标，以改善老年糖尿病患者的血糖、生活质量和整体健康结果。最终目标将是改善指导方针和对这一重要、流行和不断扩大的人口的护理的整体有效性。 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中进行的研究。最近在糖尿病和心血管疾病患者中进行的强化血糖控制的大型临床试验表明，老年人使用推荐的糖尿病治疗可能会遇到更大的问题。该项目的目标是调查将改善糖尿病以及生活质量和整体健康的治疗目标，并确定哪些老年糖尿病患者将从治疗中受益。

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.