title: Assessment of barriers to improve diabetes management in older adults: a randomized controlled study.
abstract: 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.
  
  
  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.
authors.affiliation: Joslin Diabetes Center, Boston, MA, USA. mmunshi@bidmc.harvard.edu
authors.forename: Medha N
authors.initials: MN
authors.lastname: Munshi
authors.forename: Alissa R
authors.initials: AR
authors.lastname: Segal
authors.forename: Emmy
authors.initials: E
authors.lastname: Suhl
authors.forename: Courtney
authors.initials: C
authors.lastname: Ryan
authors.forename: Adrianne
authors.initials: A
authors.lastname: Sternthal
authors.forename: Judy
authors.initials: J
authors.lastname: Giusti
authors.forename: Yishan
authors.initials: Y
authors.lastname: Lee
authors.forename: Shane
authors.initials: S
authors.lastname: Fitzgerald
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Staum
authors.forename: Patricia
authors.initials: P
authors.lastname: Bonsignor
authors.forename: Laura
authors.initials: L
authors.lastname: DesRochers
authors.forename: Richard
authors.initials: R
authors.lastname: McCartney
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D012648:Self Care / Q000523:psychology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents