D iabetes C ontrol in the E lderly P roject (DCEP)

Diabetes affects 20% of the U.S. population over the age of 65. Evidence indicates that

hyperglycemia (high blood sugar level) is associated with an increased risk of diabetic

complications. The treatment of diabetes in the elderly is often hampered by age- and diseaserelated co-morbidities. Many physicians treat diabetes in the elderly without aggressive attempts to achieve optimal glycemic control. The primary goal of this project was to study whether improved glycemic control could be achieved in elderly patients without undue risk for hypoglycemia (severely low blood sugar).

Materials and Methods

128 elderly patients from several primary care clinics were randomized into either an

intervention group where patients participated in intensive diabetes education, social support

and aggressive attempts using agreed upon practice guidelines to improve glycemic control; or

to a control group in which patients continued to receive their usual standard of care.

Eligible patients had to fit the following criteria to participate:

• a diagnosis of Type II diabetes

• age 65 or older

• no diagnosis of any organ failure, dementia or malignancy

• sign informed consent

Eligibility for participation did not depend on the number of years since diagnosis of Type II diabetes or on the presence/absence of diabetic complications (except those listed above). At the time of study entry, patients agreed to the use of insulin if it became necessary and agreed to participate in all recommended services.

At the baseline visit, the patient’s age, sex, years since diagnosis, current treatment with insulin (yes/no), and hemoglobin A1c (HbA1c) level were recorded. At the year 1 visit, current treatment with insulin, and the hemoglobin A1c were again recorded. In addition, the occurrence of any incidents during the study year of hypoglycemia severe enough to require assistance was recorded.

Hemoglobin A1c (HbA1c), recorded as a percentage, is interpreted as a measure of average blood sugar level during the preceding 3 months and is a commonly used measure of glycemic control in diabetes. A low value is indicative of good glycemic control (lower blood sugar levels), and higher values of poor control (high blood sugar levels). A common goal for diabetic patients is to maintain an HbA1c level below 8%. Decrease of a half unit (0.5%) is considered clinically important in decreasing risk of complications.

Data is available on 113 patients who completed the study year. There was no difference in loss-to-follow-up rates in the intervention or control groups. A code sheet describing the data is included below.

Note: These data are a subset of a larger set of data used in a more complex and thorough analysis. Do not report on these data or use them in any other setting .

Research Questions

1. Are there any differences in baseline characteristics of patients assigned to the control and intervention groups?
2. Is baseline HbA1c level associated with number of years since diagnosis?
3. (a) Is there a significant ‘improvement’ in glycemic control among the intervention patients over the study year?
   (b) Among the control patients?
4. Is there a significant difference in improvement in glycemic control between control and intervention patients?
5. (a) At study end (1 yr) is the mean HbA1c level below 8% for the control patients?
   (b) For intervention patients?
6. Is there any difference in the incidence of hypoglycemic episodes among control and

intervention patients?

Price: $20.68

Solution: The downloadable solution consists of 9 pages, 1168 words and 12 charts.
Deliverable: Word Document