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

Joslin Diabetes Center

Status: Completed

Conditions: Diabetes

Treatments: Other: Intervention for age specific barriers to self care

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT01480804

06-15

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 48 patients

Sex: All

Ages: 69+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

48 participants in 2 patient groups

Geriatric diabetes team intervention group

Experimental group

Description:

The subjects in this group underwent evaluation for barriers to self care by a diabetes educators well versed with age specific barriers. After consideration of patients clinical, functional, and psychosocial background a geriatric diabetes team devised strategy to help patients cope respective barriers. A care manager then implemented the coping strategies by educating patients and caregivers. She also made home visits to assess any safety issues not know to clinic based geriatric team. She helped the patients and caregivers with all aspects of care coordination. Patients in this group received phone contact from care managers as many times as needed over the six month intervention period.

Treatment:

Other: Intervention for age specific barriers to self care

Attention Control Group

No Intervention group

Description:

The subjects in the group received similar, in person, contact as the intervention group. An educator, separate from the one involved in the intervention team, called patents in this group for a total of eleven time within the first six months. The phone calls were forces toward general discussion without any diabetes related advice.