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OBJECTIVE This epidemiological analysis of the pooled Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort describes the equivalence of a 1-percentage point increase in HbA1c (such as from 7% to 8%) and years of additional age or duration of type 1 diabetes (T1D) relative to the risk of complications. RESEARCH DESIGN AND METHODS Separate Cox proportional hazards models determined the number of additional years of age and/or duration of T1D that would result in the same increase in risk of microvascular (retinopathy, nephropathy, and neuropathy) and cardiovascular complications and mortality as a 1-percentage point increase in HbA1c. RESULTS The risk of any cardiovascular disease associated with a 1-percentage point increase in HbA1c was equivalent to the risk associated with 4.3 (95% CI 2.7–5.9) additional years of age or 5.6 (95% CI 2.7–6.5) additional years’ duration of T1D. The risk of estimated glomerular filtration rate CONCLUSIONS Our results help evaluate the impact of glycemia on advanced complications in a way that may be more interpretable to health care providers and individuals with T1D.

IN BRIEF The use of long-acting basal insulin analogs is a recommended strategy in older people with diabetes because of their lower risk of hypoglycemia compared to intermediate-acting insulins. In this article, we review the results from recent clinical trials of second-generation basal insulin preparations. We conclude that, although these preparations have improved the management of insulin-requiring older people with type 2 diabetes, there is a need for additional and more specific studies to address the complexities of hyperglycemia management in this population.

1.This randomized control trial compared an adaptive computerized cognitive training intervention with a non-adaptive version. The primary hypothesis predicted better diabetes self-management in type 2 diabetes patients at 6 months post-intervention than baseline, with seven secondary outcomes. 2.Intent-to-treat analysis of veterans without dementia aged 55+ from the Bronx, NY and Ann Arbor, MI (N=90/per arm) used linear mixed model analyses. 3.Contrary to the hypothesis, only memory showed more improvement in the adaptive arm (p0.01). Post-hoc analyses combined the two arms; self-management improved at six-months post-intervention (p0.001). Memory, executive functions/attention, prospective memory, diastolic blood pressure, and systolic blood pressure improved (p0.05); hemoglobin A1c and medication adherence did not improve significantly. 4.The adaptive computerized cognitive training was not substantially better than non-adaptive, but may improve memory. Post-hoc results for the combined arms suggest computer-related activities may improve diabetes self-management and other outcomes for middle-aged and older patients with type 2 diabetes. Practice effects or awareness of being studied cannot be ruled out.

Introduction Associations of some risk factors with poor cognition, identified prior to age 75, are reduced or reversed in very old age. The Protected Survivor Model predicts this interaction due to enhanced survival of those with extended risk factor duration. In a younger sample, this study examines the association of cognition with the mean hemoglobin A1c risk factor over the time at risk, according to its duration. Methods The interaction of mean hemoglobin A1c (average = 9.8%), evaluated over duration (average = 116.8 months), was examined for overall cognition and three cognitive domains in a sample of 150 “young-old” veterans (mean age = 70) with type 2 diabetes. Results The predicted interactions were significant for overall cognition and attention, but not executive functions/language and memory. Discussion Findings extend the Protected Survivor Model to a “young-old” sample, from the very old. This model suggests focusing on individuals with good cognition despite prolonged high risk when seeking protective factors.

Sarcopenia and diabetes mellitus are two common chronic diseases associated with aging. Sarcopenia is characterized by decrease in muscle mass and function (strength and/or physical performance). Diabetes is characterized by hyperglycemia: in type 1 diabetes, hyperglycemia is secondary to almost absolute insulin deficiency, whereas in type 2 diabetes, hyperglycemia is secondary to progressive relative insulin deficiency in an insulin resistance state. Patients with diabetes have a higher prevalence of sarcopenia compared with controls and patients with sarcopenia have an increased prevalence of diabetes. In this chapter we reviewed sarcopenia in general and specifically the preclinical and clinical aspects of sarcopenia associated with diabetes mellitus—definition, classification, diagnostic criteria, epidemiology, economic burden, pathogenesis, clinical presentation and interventions. Patients with type 2 diabetes show an accelerated decline in muscle mass and strength. Sarcopenia associated with diabetes is a common, growing and costly public health problem.

Diabetes is frequently not recorded on the death certificates of decedents with type 2 diabetes (1). Less is known about the recording of diabetes for decedents with type 1 diabetes (2–4). We describe the recording of diabetes on death certificates for decedents with type 1 diabetes who participated in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) (ClinicalTrials.gov reg. nos. NCT00360815 and NCT00360893, respectively). We investigated whether the word(s) “diabetes,” “diabetes mellitus,” “type 1 diabetes,” “type 2 diabetes,” or their abbreviations appeared as the underlying cause of death (last listed cause of death in part I of the death certificate) or anywhere on the death certificate. We defined end-stage renal disease, chronic renal failure, and diabetic ketoacidosis as diabetes-related underlying causes of death. Covariates included age and duration of diabetes at death, sex, race/ethnicity, education, last recorded treatment group, BMI, and smoking status at baseline. Study coordinators at each DCCT/EDIC site determined whether the person who signed the death certificate was the decedent’s primary care physician (PCP). The t test and χ2 test were used to identify variables associated with recording diabetes. By April 2016, 134 DCCT/EDIC participants had died. Death certificates were available for 95 (71%), and 91 recorded a cause of death. The characteristics of the 43 decedents without death certificates did not differ from the 91 with death certificates that recorded a cause of death. The …

Over one quarter of adults ≥65 years of age with diabetes report falling in the preceding 2 years. We hypothesized that participants in the Look AHEAD intensive lifestyle intervention (ILI) would have fewer falls compared to those who received diabetes support and education (DSE) only. The Look AHEAD study randomly assigned participants (aged 45-76 years) with type 2 diabetes and body mass index (BMI) ≥25 kg/m2 to ILI (diet and physical activity to induce ≥7% of initial weight) or DSE. We compared baseline characteristics of participants who reported 0, 1, or 2+ falls at year 8, by intervention group, and built multinomial logistic regression models to predict falls. Older adults with diabetes randomly assigned to the ILI compared to those in the DSE were less likely to fall 2 or more times at 8-year follow-up in the Look AHEAD study (β= -0.18, p = 0.01). Disclosure P.G. Lee: Advisory Panel; Self; T1D Exchange. Other Relationship; Self; Sanofi. K.P. Pokhrel: None. W.H. Herman: Consultant; Self; Janssen Scientific Affairs, LLC. Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.

Background Type 2 diabetes mellitus (T2DM) is prevalent in the general United States population, and in the veteran population. T2DM has consistently been linked to increased risk for cognitive impairment, dementia, and Alzheimer's disease. Computerized cognitive training (CCT) is practical and inexpensive cognitive interventions that is an alternative to medication. Objective To report the recruitment methods and challenges to date in an ongoing two-site randomized controlled trial (RCT) of CCT on cognitive function and T2DM management in an older non-demented veteran population. Methods Veterans are recruited primarily by targeted mailings or by direct contact at clinics and presentations. Results From 1,459 original contacts, 437 expressed initial interest, 111 provided informed consent, and 97 completed baseline assessments. Participants from the two VA Medical Centers differed in demographics and baseline characteristics. Comparing recruitment methods, the proportion of individuals contacted who were ultimately consented was significantly less from mailings (5%) than other sources (20%), primarily face- to-face clinic visits (χ2 (1) = 38.331, p Conclusions Mailings are cost-effective, but direct contact improved recruitment. Not using or lacking access to computers and ineligibility were major reasons for non-participation. Within-site comparisons of demographically diverse sites can address confounding of demographic and other site differences.

Previous research has found that bilingual speakers' first (L1) and second languages (L2) are differentially associated with their emotional experiences. Moreover, bilinguals appear to code-switch (alternate between two or more languages in a single conversation) during emotional episodes. However, prior evidence has been limited to clinical case studies and self-report studies, leaving open the specificity of the link between code-switching (CS) and emotion and its underlying mechanisms. The present study examined the dynamic associations between CS and facial emotion behavior in a sample of 68 Chinese American parents and children during a dyadic emotion-inducing puzzle box task. Specifically, bilingual parents' language use (L1 Chinese or L2 English), CS behavior (L1→L2 or L2→L1 switches), and facial emotion behavior (positive and negative valence) were coded at each 5-s interval. Multilevel modeling was used to analyze whether facial emotion behavior predicted later CS and vice versa. We found that negative facial emotion predicted higher subsequent CS in both L1→L2 and L2→L1 directions, with stronger associations for the L2→L1 direction. On the other hand, positive facial emotion was associated with lower contemporaneous L2→L1 CS. CS did not predict later facial emotion behavior, suggesting language switching may not have an immediate effect on emotion. The present findings are consistent with the idea that emotional arousal, especially negative arousal, reduces cognitive control and may trigger spontaneous CS. Together, these findings provide insight into why bilingual speakers switch languages during emotional episodes and hold implications for clinical interventions serving bilingual individuals and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE To investigate whether older veterans enrolled in two diabetes prevention programs (DPPs) in the Veterans Health Administration will have similar weight loss as younger veterans. RESEARCH DESIGN AND METHODS Post hoc analysis of data from two prospective, pragmatic, nonrandomized studies of behavioral weight management interventions that were delivered in-person (Department of Veterans Affairs [VA]-DPP) or online (Online-DPP), comparing participation and weight loss between participants aged ≥65 years (N = 120) vs. RESULTS Over 70% of participants in both age groups completed eight or more sessions within 6 months; a higher proportion completed eight or more sessions in the Online-DPP intervention than in the VA-DPP intervention (P < 0.05). The overall weight changes at 6 and 12 months were similar across the two age groups: ∼5 kg or 5% weight loss compared with baseline (P > 0.05). CONCLUSIONS DPPs delivered in person or online can be similarly effective in older and younger veterans. Online programs may be an important means to improve the reach of DPPs for older adults.

OBJECTIVE. This study assessed the feasibility and preliminary efficacy of an online-assisted, occupational therapist–delivered, cognitive–behavioral therapy intervention to promote physical function in patients with knee osteoarthritis (KOA). METHOD. Fifty-seven participants with KOA were randomized 2:1 to the Engage program (eight clinic-based sessions supported by online modules) or usual care. Using analysis of covariance, we estimated Engage’s effect on physical function (Western Ontario and McMaster Universities Osteoarthritis Index’s Physical Function subscale [WOMAC–PF]) at 6 mo. RESULTS. Data were analyzed on 46 completers. Engage was associated with a small effect (η2 = 0.01) on the WOMAC–PF. More Engage participants than controls reported much or very much improvement (45% vs. 13%; p = .03). Satisfaction was high, and 30 of 31 participants attended six sessions or more. CONCLUSION. An online-supported cognitive–behavioral program for people with KOA delivered by occupational therapists is feasible and may contribute to improved physical function.

Objectives To determine whether receiving more recommended diabetes mellitus (DM) care processes (tests and screenings) would translate into better 9-year survival for middle-aged and older adults. Design Longitudinal mortality analysis using the Health and Retirement Study Diabetes Mailout Survey. Setting Health and Retirement Study (HRS). Participants Individuals aged 51 and older (n = 1,879; mean age 68.8 ± 8.7, 26.5% aged ≥75) with self-reported DM who completed the Diabetes Mailout Survey and the core 2002 HRS survey. Measurements A composite measure of five self-reported diabetes mellitus care process measures were dichotomized as greater (3–5 processes) versus fewer (0–2 processes) care processes provided. Cox proportional hazards models were used to test relationships between reported measures and mortality, controlling for sociodemographic characteristics, function, comorbidities, geriatric conditions, and insulin use. Results Prevalence of self-reported care processes was 80.1% for glycosylated hemoglobin test, 75.9% for urine test, 67.5% for eye examination, 67.7% for aspirin counseling, and 48.2% for diabetes education. In 9 years, 32.1% respondents died. Greater care correlated with 24% lower risk of dying (adjusted hazard ratio = 0.76, 95% confidence interval = 0.64–0.91) at 9-year follow up. When respondents were age-stratified (≥75 vs

Background The Community Healthy Activities Model Program for Seniors (CHAMPS) survey, summarized into weekly caloric expenditures, is a common physical activity (PA) assessment tool among older adults. Specific types of PA reported in the CHAMPS have not been systematically analyzed. We applied latent class analysis to identify the patterns of PA among sedentary older adults with diabetes reported in the CHAMPS survey. Methods Latent class models of PA were identified using the CHAMPS survey data reported by 115 individuals aged ≥60 years with type 2 diabetes whom volunteered for a clinical study of PA. Multinomial logistic regression was used to assess independent predictors of a specific latent class, including age, sex, and performance in physical function tests. Results Ninety-three percent of the participants were classified into 3 latent classes. Participants in latent class 1 (60.9%) primarily reported domestic-focused activities. Participants in latent class 2 and 3 (19.5% and 19.6%, respectively) reported domestic-focused activities, in addition to leisure-time physical activities and structured exercise activities. Latent class 1, with more women than men (73% vs.27%), had the lowest caloric expenditure, whereas class 3, with fewer women than men (28% vs. 72%), had the highest caloric expenditure (all p

Poor glycemic control (i.e., high A1c) among older adults with type 2 diabetes (DM) is associated with high risk of cognitive impairment across various domains of cognitive assessments. Older Veterans with DM have not been well studied. We hypothesized that high A1c is associated with worse executive function among older Veterans with DM.

Objectives: To identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes. Design: Observational cohort study. Setting: Pooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs. Participants: Older adults receiving ambulatory care (N = 1,015). Measurements: To prioritize and reduce the QIs into subsets, an expert panel rated each of 69 ambulatory care QIs for the strength of the link between process and benefit, defined as direct trial evidence on older adults or high expectation of benefit if a trial were conducted in older adults. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE Quality for Survival (AQS)-17), five QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms (AQQ-16). Whether AQS-17 would predict 3-year survival was first tested in 1,015 pooled ACOVE-1 and ACOVE-2 participants. Second, whether AQF-5 (n = 74) and AQQ-16 (n = 359) would predict change in the Physical Component Summary (PCS) score of the Medical Outcomes Study 12-item Short-Form Survey at 1 year was tested in the ACOVE-2 cohort. Control variables were age, function-based vulnerability, and comorbidity. Results: Each 20-percentage-point increment in AQS-17 was associated with survival (hazard ratio (HR) = 0.83, P = .01) up to 500 days but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS score (1.13-points per 20%-point increment in AQF-5, P = .02). Conclusion: Subsets of care processes can be linked with outcomes important to older adults. The AQS-17 and AQF-5 are potential tools for improving ambulatory care of older adults.

The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations.

Aims To examine the association between physical functioning and mortality in people with type 2 diabetes, and determine if this association differs by race/ethnicity in managed care. Methods We studied 7894 type 2 diabetic patients in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Physical functioning was assessed with the Short Form Health Survey. The National Death Index was searched for deaths over 10 years of follow-up (2000–2009). Results At baseline, mean age was 61.7 years, 50% were non-Hispanic White, 22% were Black, and 16% of participants reported good physical functioning. Over 10 years, 28% of participants died; 39% due to cardiovascular disease. Relative to those reporting good functioning, those reporting poor physical functioning had a 39% higher all-cause death rate after adjusting for age, sex, race/ethnicity, education, income, body mass index, smoking, and comorbidities (Hazard Ratio = 1.39; 95% Confidence Interval: 1.16, 1.67). Although Blacks were less likely than Whites to report good functioning (p Conclusions In this managed care population, self-reported physical functioning was a robust independent predictor of mortality and may be a useful benchmark for tailoring clinical care.

OBJECTIVE To describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes. RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis of 5,991 respondents ≥53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA1c) of 5.7–6.4%. Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA1c ≥6.5%) or normoglycemia (no diabetes history and HbA1c RESULTS Twenty-eight percent of respondents ≥53 years of age had prediabetes; 32% had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56% had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33% had upper-extremity limitations (pushing or pulling heavy objects and/or lifting >10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P < 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio [OR] 1.48), the lower extremities (OR 1.35), and the upper extremities (OR 1.37) (all P < 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (OR 1.21, P < 0.05). CONCLUSIONS Comorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations.

Nearly a quarter of older adults in the U.S. have type 2 diabetes, and this population is continuing to increase with the aging of the population. Older adults are at high risk for the development of type 2 diabetes due to the combined effects of genetic, lifestyle, and aging influences. The usual defects contributing to type 2 diabetes are further complicated by the natural physiological changes associated with aging as well as the comorbidities and functional impairments that are often present in older people. This paper reviews the pathophysiology of type 2 diabetes among older adults and the implications for hyperglycemia management in this population.

Aims To examine the relationship between physical function limitations and diabetes self-management, processes of care, and intermediate outcomes in adults ≥65 years of age with type 2 diabetes.

OBJECTIVE The goals of this study were to examine trajectories of blood pressure (BP) in adults with diabetes and investigate the association of trajectory patterns with mortality. RESEARCH DESIGN AND METHODS A nonconcurrent longitudinal design was used to monitor 3,766 Medicare patients with diabetes from 2005 through 2008. Data were extracted from a registry of Medicare beneficiaries, which was developed by a large academic practice that participated in the Physician Group Practice Medicare Demonstration. The relationship between BP trajectories and all-cause mortality was modeled using multilevel mixed-effects linear regression. RESULTS During the 4-year study period, 10.7% of the patients died, half of whom were aged ≥75 years. The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die. In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P < 0.001) in the years before death and by 0.7 mmHg/year (P < 0.001) in those who did not die (P < 0.001 for the difference in slopes). Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P < 0.001) and by 0.6 mmHg/year for those who did not die (P < 0.001); the difference in slopes was significant (P = 0.021). CONCLUSIONS Systolic and diastolic BP both declined more rapidly in the 4 years before death than in patients who remained alive.

Thiazolidinedione (TZD) treatment has been associated with fractures. The purpose of this study was to examine the association between TZD treatment and fractures in type 2 diabetic patients.Using data from Translating Research into Action for Diabetes, a multicenter prospective observational study of diabetes care in managed care, we conducted a matched case-control study to assess the odds of TZD exposure in patients with type 2 diabetes with and without fractures. We identified 786 cases based on fractures detected in health plan administrative data. Up to four controls without any fracture diagnoses were matched to each case. Controls were matched on health plan, date of birth within 5 yr, sex, race/ethnicity, and body mass index within 5 kg/m(2). We performed conditional logistic regression for premenopausal and postmenopausal women and men to assess the odds of exposure to potential risk factors for fracture, including medications, self-reported limited mobility, and lower-extremity amputations.We found statistically significant increased odds of exposure to TZDs, glucocorticoids, loop diuretics, and self-reported limited mobility for women 50 yr of age and older with fractures. Exposure to both loop diuretics and TZDs, glucocorticoids, and insulin and limited mobility and lower-extremity amputation were associated with fractures in men.Postmenopausal women taking TZDs and the subset of men taking both loop diuretics and TZDs were at increased risk for fractures. In postmenopausal women, risk was associated with higher TZD dose. No difference between rosiglitazone and pioglitazone was apparent.

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality. DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS). SETTING: Nationally representative health interview survey. PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older. MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education). RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P

Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from preoperatively up to two time points postoperatively to assess for recovery.We interviewed patients aged ≥ 65 y preoperatively and repeated functional and cognitive assessments at 4-6 wk and 4-6 mo postoperatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict postoperative recovery overall, adjusting for comorbidity.A total of 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Preoperative activities of daily living (ADL) impairment was associated with poorer functional recovery at 4-6 wk postoperatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (P0.05). By 4-6 mo, we could no longer detect a difference in recovery. Preoperative cognition and physical activity were not associated with postoperative changes in these domains.A preoperative and postoperative evaluation of function and cognition was integrated into the surgical care of older patients. Preoperative impairments in ADLs may be a means to identify patients who might benefit from careful postoperative planning, especially in terms of assistance with self-care during the first 4-6 wk after cardiac surgery.

Objectives To compare the safety and efficacy of adding insulin glargine or neutral protamine Hagedorn (NPH) insulin to existing oral antidiabetic drug (OAD) regimens in adults with type 2 diabetes mellitus. Design Pooled analysis of data from five randomized controlled trials with similar designs. Setting Three hundred forty-two centers in more than 30 countries worldwide. Participants Randomly selected individuals aged ≤ 80 with a body mass index ≤ 40 kg/m2 and a glycosylated hemoglobin (HbA1c) level of 7.5% to 12.0%. Measurements Fixed- and random-effects models were used to compare outcomes after 24 or 28 weeks of treatment (insulin glargine, n = 1,441; NPH insulin, n = 1,254) according to age (≥65, n = 604 vs

Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes.Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006).Respondents 51 years and older in 2004 (n=18,908).Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain.Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased.Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.

To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).Nationally representative health interview survey.Respondents in the 2004 wave of the HRS aged 65 and older.Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions.Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.