Identifying and Overcoming Barriers to Diabetes Management in the Elderly: An Intervention Study

In this randomized controlled study, we evaluated the effect of assessment and intervention for age-specific barriers, on the glycemic control and other clinical, functional and psychosocial parameters in 100 subjects over the age of 69 years with poorly controlled diabetes. The intervention group had an assessment of age-specific barriers followed by designing strategies to improve their ability to follow diabetes management plans as prescribed by their providers. The interventions were implemented by a care manager in half subjects and via phone calls from the office in the other half of the group. The attention control subjects received equal number of courtesy phone calls by an educator. All subjects underwent measurement of glycemic control (A1C) and other outcome measures at baseline and 6-months. Second assessment of outcome measures was performed in all patients at 12-months from baseline (after 6 months of no contact with study team) to assess if changes during intervention were sustained. The important results show 1) there are many barriers to self-care in older adults. 2) Phone communication between clinic visits by an educator improves glycemic control and lowers diabetes-related distress 3) Communication with an educator cognizant of age-specific barriers may improve glycemic control more and help maintain functionality 4) Hypoglycemic episodes are common in even in poorly controlled older patients on insulin regimen.
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