Type 2 Diabetes Management in Older Adults: A Personalized Approach

Abstract

Aging is considered a significant risk factor for diabetes, and over the next decade, the largest increase in diabetes prevalence is expected to be in older adults. Our study aimed to investigate the challenges in managing type 2 diabetes in older adults and its multifactorial components that affect diabetes goal setting. “My Diabetes GOAL” hypothesized that a nursing intervention, along with a collaborative approach to management, education, and care, can engage older patients in personalized goal setting and address barriers to quality of life. A total of 88 patients with type 2 diabetes mellitus were included in this 6-month randomized controlled trial, with 42 patients enrolled in the intervention arm and 46 patients in the delayed-start control arm. Patients were required to complete a survey delivered through the patient portal to initiate personalized goal setting and care management support. Patients in the intervention arm received their first telephonic care management call by a study team nurse within five business days of the initial survey completion. The nurse discussed survey responses, barriers, and concerns the patient may have involving their care. Barriers included hypoglycemia, medication, co-morbidity, and physical activity. For this abstract, we report the frequency of care management topics for all 88 patients. The majority of our patient population identified as African American (68%) and female (68%). The average A1c at baseline was 7 %. For every monthly call, A1c goal setting and education was a required discussion topic and did not vary significantly throughout the intervention (73% month one, 74% month six). During the first call, hypoglycemia was addressed among 56% of participants, and education on medication was provided to 64%. Co-morbidities (heart failure, incontinence, depression, chronic pain, falls, lung conditions, malignancies) were highly prevalent, with 68% having one or more. Physical activity was discussed in 42% of conversations with participants, and a referral (diabetes education, physical therapy) was needed by 25%. After six months, discussions regarding hypoglycemia (14%), medication (19%), co-morbidities (56%), physical activity (22%), and referrals (6%) were reduced. These results suggest that personalized telephonic care management for older adults can positively impact patient outcomes. Diabetes care management is not a one size fits all. Personalized goal setting was successfully discussed based on an individual’s risk factor, which took into consideration co-morbidities and physical mobility barriers. Future studies should evaluate long-term clinical outcomes with a randomized control design.