Identifying and Overcoming Barriers to Diabetes Management in the Elderly: An Intervention Study
Annual rept. 1 Jun 2008-31 May 2009
JOSLIN DIABETES CENTER BOSTON MA
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This study investigates whether short-term focused intervention by a geriatric multidisciplinary team with the addition of a geriatric life specialist is superior to usual care with attention control in improving glycemic control and quality of life parameters in elderly patients with diabetes, and whether these interventions will have persistent effects on outcome measures. The study also evaluates improvement in cerebral perfusion in elderly with type 2 diabetes following a 6-month intervention, and assesses whether changes in cerebral perfusion persist at a 1-year follow-up. During this research period, the authors have continued to recruit patients over age 70 with diabetes and poor glycemic control and randomized them to either the geriatric diabetes intervention team GDT or the attention control team ACT. They have now recruited 20 subjects for the control group and 21 subjects for the intervention group. All subjects have completed the initial cerebral blood flow study. The following observations are reported 1 higher exercise capacity in older adults with diabetes is associated with better self-care ability and less diabetes-related stress 2 unrecognized errors in insulin injection techniques are frequent in older adults, even when they have a long duration of insulin use 3 inadequate social resources are associated with increased clinical, functional, and economic burdens in older adults and 4 the risk of hypoglycemia is a treatment-limiting factor in older adults even with poor glycemic control. The authors received permission from the Human Research Protections Office to perform continuous glucose monitoring on study subjects at baseline, 6 months, and 12 months to assess glycemic patterns and glucose excursions, and to assess the effects of intervention on these parameters. They expect to perform interim analysis on these data soon.
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