Clinical complexity and mortality in middle-aged and older adults with diabetes

Abstract

Background: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

Methods: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

Results: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%.

Conclusions: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

Figure 1.

Kaplan Meier survival curves for diabetes clinical groups. Weighted percentages were derived using Health and Retirement Study respondent population weights to adjust for differential probability of selection into the sample and differential nonresponse.

Figure 2.

Mortality at 5 y by age and clinical groups. Weighted percentages were derived using Health and Retirement Study respondent population weights to adjust for differential probability of selection into the sample and differential nonresponse.