Correlates of Quality of Life in Older Adults With Diabetes

Abstract

OBJECTIVETo evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes.RESEARCH DESIGN AND METHODSA race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes, aged 60 to 75 years, enrolled in Kaiser Permanente Northern California, who completed a survey that included a HRQL instrument based on the Short Form 8-item health survey. Administrative records were used to ascertain diagnoses of geriatric syndromes, diabetes complications, and hypoglycemia. Associations were estimated between HRQL and exposures in exposure-specific and combined exposure models (any syndrome, any complication, or hypoglycemia). Conservatively, differences of ≥3 points were considered the minimally important difference in HRQL scores.RESULTSHRQL was lower with nearly all exposures of interest. The lowest physical HRQL was associated with amputation. In combined exposure models, geriatric syndromes (−5.3 [95% CI −5.8 to −4.8], P < 0.001) and diabetes complications (−3.5 [−4.0 to −2.9], P < 0.001) were associated with lower physical HRQL. The lowest mental HRQL was associated with depression, underweight (BMI <18 kg/m2), amputation, and hypoglycemia. In combined exposure models, only hypoglycemia was associated with lower mental HRQL (−4.0 [−7.0 to −1.1], P = 0.008).CONCLUSIONSGeriatric syndromes and hypoglycemia are associated with lower HRQL to a comparable degree as diabetes complications. Addressing geriatric syndromes and avoiding hypoglycemia should be given as high a priority as preventing diabetes complications in older adults with diabetes.

Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus

“…First, our study adds to literature by confirming that racially and ethnically diverse older women with diabetes are at high risk of urinary incontinence. 23 Combined with previous studies from the Diabetes and Aging Study, which showed a strong relationship between urinary incontinence and healthrelated quality of life, 24 our results reinforce the importance of asking about, diagnosing, and treating urinary incontinence in diverse older women with diabetes. 25 Second, for older women with diabetes and incontinence, improving glycemic control has often been advocated as a means of improving urinary incontinence symptoms.…”

Management of Type 1 Diabetes in Older Adults

“…Coexisting chronic medical conditions such as hypertension, chronic kidney disease, heart failure, chronic lung disease, musculoskeletal conditions, cancer, and history of stroke require particular attention. These comorbidities can have profound impacts on functional status and quality of life 20,21 and affect insulin requirements and self-care abilities. Older adults with type 1 diabetes may require frequent adjustments in insulin dosing, especially during acute illnesses, to decrease the likelihood of …”

“…Older adults may also have other medical comorbidities, functional disabilities, erratic food intake, and insufficient social support. Individuals with geriatric syndromes (i.e., chronic pain, urinary incontinence, polypharmacy, cognitive impairment, frequent falls, and depression) [20][21][22][23] face additional difficulties in performing self-management tasks and lower quality of life. Clinical, functional, and psychosocial factors that should be identified and addressed when developing treatment plans are listed in Table 1 and discussed below.…”

11. Older Adults:Standards of Medical Care in Diabetes—2018

“…Social difficulties may impair their quality of life and increase the risk of functional dependency (38). The patient's living situation must be considered, as it may affect diabetes management and support.…”

“…Those receiving palliative care (with or without hospice) may require an approach that emphasizes comfort and symptom management, while deemphasizing strict metabolic and blood pressure control. (38).…”