title: Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study.
abstract: BACKGROUND
  Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.
  
  
  OBJECTIVE
  To investigate how many older and middle-aged adults with diabetes have such health status characteristics.
  
  
  METHODS
  Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.
  
  
  METHODS
  Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).
  
  
  METHODS
  Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.
  
  
  RESULTS
  Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.).
  
  
  CONCLUSIONS
  Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of Michigan and Veterans Administration Health Center, 300 N. Ingalls St., Ann Arbor, MI 48109, USA. cblaum@umich.edu
authors.forename: Caroline
authors.initials: C
authors.lastname: Blaum
authors.forename: Christine T
authors.initials: CT
authors.lastname: Cigolle
authors.forename: Cynthia
authors.initials: C
authors.lastname: Boyd
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Tian
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.forename: David R
authors.initials: DR
authors.lastname: Weir
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D038321:Glycemic Index; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012648:Self Care / Q000592:standards*; D012720:Severity of Illness Index; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology