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

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

The purpose of this research study is to identify barriers affecting self care in older patients with diabetes and to provide coping strategies for these barriers with help from a care manager (Geriatric Life Specialist) to improve clinical, economical, functional and psychosocial parameters.

This is a study to evaluate whether short term focused intervention by a geriatric diabetes team, with addition of a care manager, to help overcome barriers to diabetes care in older adults will result in improved clinical, functional, and quality of life measures compared to usual care. In addition, we will assess whether the support network formed during intervention by the geriatric diabetes team will empower patients, resulting in long lasting improvement in parameters after intervention is completed. We will also explore whether improved blood glucose control will improve blood circulation in the brain that is compromised in elderly with diabetes.

Inclusion Criteria:

• Age 70 years and older
• Diagnosis of type 1 or type 2 diabetes
• Seen at Joslin Clinic or Beth Israel Deaconess Medical Center for at least one year
• HbA1c 8% X 2 in past 6 months without fluctuation of more than 0.5% (i.e. stable poor control)
• No major change in medications in past 3 months, e.g. addition of insulin or another hypoglycemic agent

Exclusion Criteria:

• Patients with terminal diseases, e.g. malignancy with life expectancy of 12 months or less
• Patients who live more than 25 miles from Joslin Clinic/ Beth Israel Deaconess Medical Center
• Patients who live in an institutional setting, e.g. nursing home, group home, etc
• Patients who are not able to complete outcome assessments,(e.g. poor vision, diminished mental capacity/severe cognitive decline, unable to speak/read/write English, etc)
• Patients will be excluded from participation in Study Aim 3 if they have a history of orthostatic hypotension, TIA, or vertebral basilar insufficiency