Assessment of Barriers to Improve Diabetes Management in Older Adults
A randomized controlled study
- Medha N. Munshi, MD1,2,3⇓,
- Alissa R. Segal, PHARMD, CDE1,4,
- Emmy Suhl, RD, CDE1,
- Courtney Ryan, BS1,
- Adrianne Sternthal, BS1,
- Judy Giusti, RD, CDE1,
- Yishan Lee, MS1,
- Shane Fitzgerald, MS1,
- Elizabeth Staum, RD, CDE1,
- Patricia Bonsignor, RN, CDE1,
- Laura DesRochers, BS1,
- Richard McCartney, BS1 and
- Katie Weinger, EDD1,3
- 1Joslin Diabetes Center, Boston, Massachusetts
- 2Beth Israel Deaconess Medical Center, Boston, Massachusetts
- 3Harvard Medical School, Boston, Massachusetts
- 4Massachusetts College of Pharmacy for Health Sciences, Boston, Massachusetts
- Corresponding author: Medha N. Munshi, .
OBJECTIVE To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control. The American Diabetes Association guidelines recommend the assessment of age-specific barriers. However, the effect of such strategy on outcomes is unknown.
RESEARCH DESIGN AND METHODS We randomized 100 subjects aged ≥69 years with poorly controlled diabetes (A1C >8%) in two groups. A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group. The control group received equal amounts of attention time. The active intervention was performed for the first 6 months, followed by a “no-contact” period. Outcome measures included A1C, Tinetti test, 6-min walk test (6MWT), self-care frequency, and diabetes-related distress.
RESULTS We assessed 100 patients (age 75 ± 5 years, duration 21 ± 13 years, 68% type 2 diabetes, 89% on insulin) over 12 months. After the active period, A1C decreased by −0.45% in the intervention group vs. −0.31% in the control group. At 12 months, A1C decreased further in the intervention group by −0.21% vs. 0% in control group (linear mixed-model, P < 0.03). The intervention group showed additional benefits in scores on measures of self-care (Self-Care Inventory-R), gait and balance (Tinetti), and endurance (6MWT) compared with the control group. Diabetes-related distress improved in both groups.
CONCLUSIONS Only attention between clinic visits lowers diabetes-related distress in older adults. However, communication with an educator cognizant of patients’ barriers improves glycemic control and self-care frequency, maintains functionality, and lowers distress in this population.
- Received July 3, 2012.
- Accepted August 27, 2012.
- © 2013 by the American Diabetes Association.
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