title: Clinical complexity and mortality in middle-aged and older adults with diabetes.
abstract: BACKGROUND
  Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.
  
  
  METHODS
  We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.
  
  
  RESULTS
  The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%.
  
  
  CONCLUSIONS
  This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.
authors.affiliation: Department of Family Medicine, University of Michigan, 300 N. Ingalls, Room 919, Ann Arbor, MI 48109-2007, USA. ccigolle@umich.edu
authors.forename: Christine T
authors.initials: CT
authors.lastname: Cigolle
authors.forename: Mohammed U
authors.initials: MU
authors.lastname: Kabeto
authors.forename: Pearl G
authors.initials: PG
authors.lastname: Lee
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blaum
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012648:Self Care