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Determinants of Quality of Life in Elderly Adults with Diabetes

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I am a general internist and research fellow with a long-term goal of becoming an independent investigator with a focus on the elderly with complex chronic diseases. To complete this goal, I am seeking additional coursework, training, and research experience. Diabetes is a complex chronic disease that disproportionately affects the elderly and is associated with worse quality of life. Recent guidelines suggest that the care of elderly diabetes patients should include screening and managing geriatric syndromes like falls, urinary incontinence, dementia, depression, chronic pain, and frailty. However, there is little justification for these recommendations. A complicated interrelationship likely exists between traditional diabetes complications, geriatric syndromes, and quality of life. For example, both foot ulcers and falls likely contribute to a worse quality of life;however, foot ulcers may lead to gait instability and a fall, which would lead to lower quality of life. Additionally, there may be subgroups of elderly diabetes patients for whom diabetes complications and geriatric syndromes are especially associated with poor quality of life. Quality of life is also measured by health economists in terms of quantitative values known as health state utility values. The development of utility values for traditional diabetes complications and geriatric syndromes in elderly patients would allow for cost-effectiveness analyses of interventions for these medical problems. Consideration of geriatric syndromes in diabetes patients may alter the traditional approaches to glucose management and overall diabetes care and help providers prioritize care for these complex patients. Specific Aims: 1) To examine the complex interrelationships between geriatric syndromes, traditional diabetes complications, and quality of life;2) To identify socio-demographic subgroups of elderly diabetes patients at particularly high risk for poor quality of life and to assess the contributions of geriatric syndromes and/or diabetes complications;3) To quantify health state utility values for specific geriatric syndromes and diabetes- related complications in elderly diabetes patients. These goals will be achieved by a rigorous analysis of existing data of a well-characterized, multi-ethnic cohort of adult patients over 60 years old with diabetes using multiple linear regression modeling and an algorithm-based transformation of quality of life scores for each geriatric syndrome and diabetes complications into health state utility values. This research proposal will fill large gaps in medical knowledge concerning the effects of diabetes on quality of life of elderly adults. Additionally, health state utility values for geriatric syndromes and diabetes complications in elderly diabetes patients will allow for cost-effectiveness analysis of future treatments and programs. The completion of these aims during the course of this fellowship will also be critical for my long-term goals of developing into an investigator in the areas of geriatric diabetes and care prioritization.

PUBLIC HEALTH RELEVANCE: Diabetes mellitus disproportionately affects elderly patients and is an expensive complex chronic disease. The elderly diabetes population is heterogeneous and the fastest growing age group of diabetes patients. However, little research exists regarding their care. Determining the factors that affect quality of life in elderly diabetes patients could have wide-ranging clinical implications because of the high prevalence of diabetes in this population. Additionally, understanding the effects of traditional diabetes complications and geriatric syndromes on quality of life could help physicians prioritize the complex medical problems in elderly diabetes patients. The development of utility scores for diabetes complications and geriatric syndromes would allow for cost-effectiveness and cost utility analyses of future treatments and programs.

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