title: Effect of diabetes on caregiver burden in an observational study of individuals with Alzheimer's disease.
abstract: BACKGROUND
  The burden on caregivers of patients with Alzheimer's disease (AD) is associated with the patient's functional status and may also be influenced by chronic comorbid medical conditions, such as diabetes. This post-hoc exploratory analysis assessed whether comorbid diabetes in patients with AD affects caregiver burden, and whether caregivers with diabetes experience greater burden than caregivers without diabetes. Caregiver and patient healthcare resource use (HCRU) were also assessed.
  
  
  METHODS
  Baseline data from the GERAS observational study of patients with AD and their caregivers (both n = 1495) in France, Germany and the UK were analyzed. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Caregiver time on activities of daily living (ADL: basic ADL; instrumental ADL, iADL) and supervision (hours/month), and caregiver and patient HCRU (outpatient visits, emergency room visits, nights hospitalized) were assessed using the Resource Utilization in Dementia instrument for the month before the baseline visit. Regression analyses were adjusted for relevant covariates. Time on supervision and basic ADL was analyzed using zero-inflated negative binomial regression.
  
  
  RESULTS
  Caregivers of patients with diabetes (n = 188) were younger and more likely to be female (both p < 0.05), compared with caregivers of patients without diabetes (n = 1307). Analyses showed caregivers of patients with diabetes spent significantly more time on iADL (+16 %; p = 0.03; increases were also observed for basic ADL and total caregiver time but did not reach statistical significance) and had a trend towards increased ZBI score. Patients with diabetes had a 63 % increase in the odds of requiring supervision versus those without diabetes (p = 0.01). Caregiver and patient HCRU did not differ according to patient diabetes. Caregivers with diabetes (n = 127) did not differ from those without diabetes (n = 1367) regarding burden/time, but caregivers with diabetes had a 91 % increase in the odds of having outpatient visits (p = 0.01).
  
  
  CONCLUSIONS
  This cross-sectional analysis found caregiver time on iADL and supervision was higher for caregivers of patients with AD and diabetes versus without diabetes, while HCRU was unaffected by patient diabetes. Longitudinal analyses assessing change in caregiver burden over time by patient diabetes status may help clarify the cumulative impact of diabetes and AD dementia on caregiver burden.
authors.affiliation: Lilly Deutschland GmbH, Bad Homburg, Germany.
authors.forename: Jeremie
authors.initials: J
authors.lastname: Lebrec
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Haya
authors.initials: H
authors.lastname: Ascher-Svanum
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, Surrey, UK. reed_catherine@lilly.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kahle-Wrobleski
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.|Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Hake
authors.affiliation: Eli Lilly and Company, Toronto, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Raskin
authors.affiliation: Eli Lilly and Company, Lilly House, Basingstoke, Hampshire, UK.|Faculty of Science, Liverpool Hope University, Liverpool, UK.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Naderali
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Schuster
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Heine
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kendall
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Activities of daily living; Alzheimer’s disease; Caregiver burden; Diabetes; Healthcare resource use; Observational study; Supervision