Decisions About Intensity of Glycemic Control Should Depend on Age and Functional Status

STUDY

Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO: The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med 149:11-19, 2008

SUMMARY

Design. A decision analysis.

Subjects. Adults ages 60-80 years with diabetes.

Methods. The authors developed a simulation model to understand the magnitude of the potential benefits of intensive (target A1C < 7.0%) versus moderate (target A1C < 7.9%) glycemic control in older adults with diabetes (both new-onset and of different levels of duration) and a range of comorbid illnesses and functional limitations. The model parameters were drawn from available trials and cohort studies. Comorbidity and functional limitations were categorized using a previously validated framework and were used to model life expectancy. The potential benefits of intensive control were expressed in average quality-adjusted life-days gained. Diabetes-related complications (e.g., blindness, end-stage renal disease, amputation, and myocardial infarction) were assigned health values (utilities) based on previous studies. The model did not consider costs …