Trends in Diabetes Medication Use and Prevalence of Geriatric Syndromes in Older Mexican Americans from 1993/1994 to 2004/2005

Abstract

Spanish

French

Background:

New diabetes medications introduced over the last decade have fed to changes in diabetes treatment recommendations for the increasing number of elderly patients with diabetes. It is, however, not clear whether these changes are accompanied by changes in prevalence of comorbid geriatric syndromes.

Objective:

To determine whether changes in diabetes treatment between 1993/1994 and 2004/2005 were accompanied by changes in prevalence of geriatric syndromes in Mexican Americans aged 75 years and older.

Methods:

Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used. Participants aged 75 years and older with diabetes in 1993/1994 (n = 264) and in 2004/2005 (n = 324; new cohort added in 2004/2005) were included in the analyses. Medication use and geriatric syndromes prevalence rates were estimated and compared using descriptive and univariate statistics for continuous variables and contingency tables (χ2) for categorical variables.

Results:

Older Mexican Americans with diabetes in 2004/2005 were more likely to be taking 2 or more oral diabetes medications than were those in the 1993/1994 cohort; most of the drugs taken by the 2004/2005 cohort were the newly introduced oral diabetes medications. Use of insulin as sole diabetes therapy decreased from 20.3% in the 1993/1994 cohort to 7.5% in the 2004/2005 cohort. The 2004/2005 cohort reported longer diabetes duration and higher prevalence of obesity and hypertension; they were also more likely than the 1993/1994 cohort to have more geriatric syndromes: pain, arthritis, incontinence, and self-reported activities of daily living disability. No significant differences exist between the 2 cohorts in objective measures of cognitive and physical function.

Conclusions:

Older Mexican Americans with diabetes in 2004/2005 used more of the newer diabetes medications and less insulin compared to the 1993/1994 cohort. The prevalence rates of geriatric syndromes were higher in the 2004/2005 cohort. Our findings suggest that screening for and treating comorbid geriatric syndromes is increasingly important for optimal geriatric diabetes care.

Keywords

diabetes medications diabetes mellitus geriatric syndromes Mexican Americans trends

Get full access to this article

View all access options for this article.

References

Centers for Disease Control and Prevention. National diabetes fact sheet. 2005. wwwjcdc.gov/diabetes/pubs/estirnatesJitrn (accessed 2008 Dec 20).

Beard

, Al Ghatrif

, Samper-Ternent

, Gerst

, Markides

. Trends in diabetes prevalence and diabetes-related complications in older Mexican Americans from 1993/1994 to 2004/2005. Diabetes Care 2009; 32:2212–7.

Karter

, Ferrara

, Liu

, Moffet

, Ackerson

, Selby

. Ethnic disparities in diabetic complications in an insured population. JAMA 2002287:2519–27.

Markides

, Eschbach

, Ray

, Peek

. Census disability rates among older people by race/ethnicity and type of Hispanic origin. In: Angel

, Whitfield

, eds. The health of aging Hispanics. New York: Springer, 2007: 26–39.

Kuo

Y-F

, Raji

, Markides

, Ray

, Espino

, Goodwin

. Inconsistent use of diabetes medications, diabetes complications, and mortality in older Mexican Americans over a 7-year period. Diabetes Care 2003;26:3054–60.

Alexander

, Sehgal

, Moloney

, Stafford

. National trends in treatment of type 2 diabetes mellitus, 1994-2007. Arch Intern Med 2008; 168:2088–94.

American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care 2009; 32: S 13–61.

ACCORD study group, Ginsberg H, Elam M, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1563–74.

ACCORD study group, Cushman W, Evans G, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362:1575–85.

10.

Inouye

, Studenski

, Tinetti

, Kuchel

. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Sec 2007; 55:780–91.

11.

Araki

, Ito

. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int 2009; 9:105–14.

12.

Huang

. Goal setting in older adults with diabetes. In: Munshi

, Lipsitz

, eds. Geriatric diabetes. New York: Informa Healthcare, 2007.

13.

Al Snih

, Fisher

, Raji

, Markides

, Ostir

, Goodwin

. Diabetes mellitus and incidence of lower body disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci 2005; 60:1152–6.

14.

Black

, Ray

, Markides

. The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Am J Public Health 1999; 89:546–52.

15.

Otiniano

, Black

, Ray

, Du

, Markides

. Correlates of diabetic complications in Mexican-American elders. Ethn Dis 2002; 12:252–9.

16.

Otiniano

, Markides

, Ottenbacher

, Ray

, Du

. Self-reported diabetic complications and 7-year mortality in Mexican American elders: findings from a community-based study of five southwestern states. J Diabetes Complications 2003; 17:243–248.

17.

Markides

, Stroup-Benham

, Goodwin

, Perkowski

, Lichenstein

, Ray

. The effect of medical conditions on the functional limitations of Mexican-American elderly. Ann Epidemiol 1996; 6:386–91.

18.

Folstein

, Folstein

, McHugh

. 'Mini-mental state.' A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–98.

19.

Crum

. Anthony JC, Basse« SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and education level. JAMA 1993; 269:2386–91.

20.

Raji

, Ostir

, Markides

, Goodwin

. The interaction of cognitive and emotional status on subsequent physical functioning in older Mexican Americans: findings from the Hispanic Established Population for the Epidemiologic Study of the Elderly. J Gerontol A Biol Sei Med Sci 2002; 57A:M678–82.

21.

Tinetti

. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34:119–26.

22.

Huang

, Sachs

, Chin

. Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients. Med Care 2006; 44:373–7.

23.

The Action to Control Cardiovascular Risk in Diabetes study group. Effects of intensive glucose lowering in Type 2 diabetes. N Engl J Med 2008; 358:2545–59.

24.

Kim

, Suzuki

, Yoshida

, Shimada

. Prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly. Nippon Ronen Igakkai Zasshi 2008; 45:414–20.

25.

Okura

, Urban

, Mahoney

, Jacobsen

, Rodeheffer

. Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction, and stroke but not for heart failure. J Clin Epidemiol 2004; 57:1096–103.

26.

Robinson

, Young

, Roos

, Gelskey

. Estimating the burden of disease: comparing administrative data and self-reports. Med Care 1997; 35:932–47.

27.

Simpson

, Boyd

, Carlson

, Griswold

, Guralnik

, Fried

. Agreement between self-report of disease diagnosis and medical record validation in disabled older women: factors that modify agreement. J Am Geriatr Soc 2004; 52:123–7.

28.

Skinner

, Miller

, Lincoln

, Lee

, Kazis

. Concordance between respondent self-reports and medical records for chronic conditions. J Ambul Care Manage 2005; 28:102–10.