Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality

J Gerontol A Biol Sci Med Sci. 2021 Oct 13;76(11):2071-2079. doi: 10.1093/gerona/glab141.

Abstract

Background: Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to reexamine the 2005-2006 classification systems in participants who are now 5 years older.

Methods: We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project. The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-2011 LCA model to that of 2005-2006. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and 5-year mortality.

Results: Both 2005-2006 LCA and the 2010-2011 LCA model fit 3 similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability = 0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality.

Conclusions: We reconfirmed 3 latent classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.

Keywords: Cardiovascular; Latent class; Stratification.