Determinants of Quality of Life in Elderly Adults with Diabetes

描述（由申请人提供）：我是一名普通内科医生和研究员，长期目标是成为一名独立的研究人员，专注于患有复杂慢性疾病的老年人。为了完成这一目标，我正在寻求额外的课程，培训和研究经验。糖尿病是一种复杂的慢性疾病，不成比例地影响老年人，并与生活质量下降有关。最近的指南建议，老年糖尿病患者的护理应包括筛查和管理老年综合征，如福尔斯、尿失禁、痴呆、抑郁、慢性疼痛和虚弱。然而，这些建议没有什么理由。传统糖尿病并发症、老年综合征和生活质量之间可能存在复杂的相互关系。例如，足部溃疡和福尔斯都可能导致生活质量下降;然而，足部溃疡可能导致步态不稳和跌倒，这将导致生活质量下降。此外，可能存在老年糖尿病患者亚组，其糖尿病并发症和老年综合征尤其与生活质量差相关。健康经济学家也用被称为健康状态效用值的量化值来衡量生活质量。传统的糖尿病并发症和老年综合征在老年患者的效用值的发展将允许这些医疗问题的干预措施的成本效益分析。考虑糖尿病患者的老年综合征可能会改变传统的血糖管理和整体糖尿病护理方法，并帮助提供者优先考虑这些复杂患者的护理。具体目标：1）检查老年综合征、传统糖尿病并发症和生活质量之间复杂的相互关系; 2）确定生活质量差风险特别高的老年糖尿病患者的社会人口学亚组，并评估老年综合征和/或糖尿病并发症的贡献; 3）量化老年糖尿病患者特定老年综合征和糖尿病相关并发症的健康状态效用值。这些目标将通过对60岁以上糖尿病成人患者的特征良好的多种族队列的现有数据进行严格分析来实现，该队列使用多元线性回归模型，并将每种老年综合征和糖尿病并发症的生活质量评分基于算法转换为健康状态效用值。这项研究提案将填补有关糖尿病对老年人生活质量影响的医学知识的巨大空白。此外，老年糖尿病患者的老年综合征和糖尿病并发症的健康状态效用值将允许未来治疗和计划的成本效益分析。在这个奖学金的过程中，这些目标的完成也将是我的发展成为老年糖尿病和护理优先领域的研究者的长期目标的关键。 公共卫生相关性：糖尿病不成比例地影响老年患者，是一种昂贵的复杂慢性疾病。老年糖尿病人群具有异质性，是糖尿病患者中增长最快的年龄组。然而，关于他们的护理研究很少。确定影响老年糖尿病患者生活质量的因素可能具有广泛的临床意义，因为糖尿病在这一人群中的患病率很高。此外，了解传统糖尿病并发症和老年综合征对生活质量的影响可以帮助医生优先考虑老年糖尿病患者的复杂医疗问题。糖尿病并发症和老年综合征的效用评分的发展将允许未来的治疗和计划的成本效益和成本效用分析。

DESCRIPTION (provided by applicant): I am a general internist and research fellow with a long-term goal of becoming an independent investigator with a focus on the elderly with complex chronic diseases. To complete this goal, I am seeking additional coursework, training, and research experience. Diabetes is a complex chronic disease that disproportionately affects the elderly and is associated with worse quality of life. Recent guidelines suggest that the care of elderly diabetes patients should include screening and managing geriatric syndromes like falls, urinary incontinence, dementia, depression, chronic pain, and frailty. However, there is little justification for these recommendations. A complicated interrelationship likely exists between traditional diabetes complications, geriatric syndromes, and quality of life. For example, both foot ulcers and falls likely contribute to a worse quality of life; however, foot ulcers may lead to gait instability and a fall, which would lead to lower quality of life. Additionally, there may be subgroups of elderly diabetes patients for whom diabetes complications and geriatric syndromes are especially associated with poor quality of life. Quality of life is also measured by health economists in terms of quantitative values known as health state utility values. The development of utility values for traditional diabetes complications and geriatric syndromes in elderly patients would allow for cost-effectiveness analyses of interventions for these medical problems. Consideration of geriatric syndromes in diabetes patients may alter the traditional approaches to glucose management and overall diabetes care and help providers prioritize care for these complex patients. Specific Aims: 1) To examine the complex interrelationships between geriatric syndromes, traditional diabetes complications, and quality of life; 2) To identify socio-demographic subgroups of elderly diabetes patients at particularly high risk for poor quality of life and to assess the contributions of geriatric syndromes and/or diabetes complications; 3) To quantify health state utility values for specific geriatric syndromes and diabetes- related complications in elderly diabetes patients. These goals will be achieved by a rigorous analysis of existing data of a well-characterized, multi-ethnic cohort of adult patients over 60 years old with diabetes using multiple linear regression modeling and an algorithm-based transformation of quality of life scores for each geriatric syndrome and diabetes complications into health state utility values. This research proposal will fill large gaps in medical knowledge concerning the effects of diabetes on quality of life of elderly adults. Additionally, health state utility values for geriatric syndromes and diabetes complications in elderly diabetes patients will allow for cost-effectiveness analysis of future treatments and programs. The completion of these aims during the course of this fellowship will also be critical for my long-term goals of developing into an investigator in the areas of geriatric diabetes and care prioritization. PUBLIC HEALTH RELEVANCE: Diabetes mellitus disproportionately affects elderly patients and is an expensive complex chronic disease. The elderly diabetes population is heterogeneous and the fastest growing age group of diabetes patients. However, little research exists regarding their care. Determining the factors that affect quality of life in elderly diabetes patients could have wide-ranging clinical implications because of the high prevalence of diabetes in this population. Additionally, understanding the effects of traditional diabetes complications and geriatric syndromes on quality of life could help physicians prioritize the complex medical problems in elderly diabetes patients. The development of utility scores for diabetes complications and geriatric syndromes would allow for cost-effectiveness and cost utility analyses of future treatments and programs.