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，美国45-60岁人口中有10.6%患有糖尿病，65-74岁人口中有19.1%患有糖尿病，75岁及以上人口中有17.6%患有糖尿病。尽管如此，糖尿病的临床研究主要是在年轻的受试者中进行的，指导方针也来源于年轻的受试者。老年糖尿病患者在生理和社会人口统计学上都是异质人群。最近对糖尿病和心血管疾病患者进行强化血糖控制的大型临床试验表明，老年人在接受推荐的糖尿病治疗时可能会遇到更大的问题。目前的老年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。本研究的目的是启动老年人糖尿病的最佳管理研究，重点是研究创新的治疗靶点，以改善糖尿病，改善生活质量和整体健康，并确定最有可能从中获益的人群。重要的未被认识到的治疗目标包括抑郁情绪、缺乏活动和睡眠障碍。这项工作的预期结果将是：(1)在全国具有代表性的社区居住的老年糖尿病患者概率样本中确定这些问题的发生率和治疗相关因素；(2)建立并分析纵向队列，以确定老年糖尿病患者的糖尿病进展、心血管疾病进展和死亡轨迹。这些目标是将临床实践的重点从狭窄的代谢测量转移到更广泛地考虑生活质量和整体健康的因素的先决条件。从该项目中吸取的经验教训将用于支持进一步的工作，以开发和测试在传统医疗保健背景下针对非传统治疗目标的广泛适用的多因素干预措施，以改善老年糖尿病患者的血糖、生活质量和整体健康结果。最终目标将是改进针对这一重要的、普遍的和不断扩大的人群的护理指南和总体有效性。

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.