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Personalizing care for older patients with diabetes

Kaiser Permanente investigator receives $3.2 million NIH grant to learn what patients want and how doctors can provide it


Older patients with Type 2 diabetes are an understudied group and particularly vulnerable to complications and adverse drug events. Over the next 5 years, Kaiser Permanente Division of Research investigators will receive $3.2 million from the National Institute of Aging to collect information about these older patients and create tools for doctors to assess their specific needs.

Andrew Karter, PhD, Kaiser Permanente Research Scientist

The two principal investigators, Andrew Karter, PhD, from Kaiser Permanente, and Elbert Huang, MD, from University of Chicago, along with colleagues and additional contributors from Yale School of Medicine, will be collaborating on a study called Optimizing Medical Decision Making for Older Patients with Type 2 Diabetes.

Diabetes patients over age 65 are a fast-growing group – whose numbers are expected to double in the next 25 years – but they have been largely excluded from major clinical trials on diabetes care. Because of this lack of evidence, Karter says, recommendations for the care of these older patients are “conflicting or ambiguous and often not well justified.”

“Most clinical guidelines acknowledge that older people with diabetes are different from younger patients and should be treated with their unique needs in mind,” Karter says. “But the various guidelines conflict on target blood glucose levels and medication use.”

For example, older patients are more prone to low blood sugar, prompting some experts to recommend re-assessing and potentially de-intensifying medication use to avoid dangerously low blood sugar. But the guidelines vary on how to implement that advice.

The Division of Research will study approximately 146,000 Kaiser Permanente patients in northern California who are over 65 and have type 2 diabetes. An important aspect of this research is learning what older patients want in their treatment, Karter said. “We know little about older patients’ preferences,” he said. “That information will help providers’ better understand the desires of their patients as a whole.”

The investigators just finished a survey of 6,000 older patients with diabetes, looking at a wide variety of topics, including their treatment preferences, self-care behaviors, and what makes it difficult to manage their disease. Together with electronic health record data, this information will provide a more complete picture of this understudied group of patients.

The investigators will also use the data to identify what glycemic levels are associated with the least adverse diabetes outcomes in this population. Ultimately, the evidence from this study will inform future clinical guidelines and be used to develop a decision support tool for clinicians individualizing diabetes care for older patients.


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