BOSTON—Can the five- and 10-year life expectancy of older diabetes patients be predicted by history of co-morbid health conditions and medication? A new study suggested it can.
The VA Boston Healthcare System-led study suggested that the ability to make such predictions might create personalized treatment goals that balance risks and benefits. Results were published in the journal Diabetes Care.1
The authors pointed out that federal and professional society clinical practice guidelines recommend that treatment goals be individualized for older adults with diabetes. “The long-term benefits of treatment intensification may not outweigh short-term risks for patients with limited life expectancy,” they added.
Because of the uncertainty of determining life expectancy for individual patients, the study team sought to develop and validate prognostic indices for mortality in older adults with diabetes. “But the guidelines don’t give doctors guidance for how to decide whether or not people fall into these different bins for life expectancy,” explained lead author Kevin N. Griffith, MD. “Furthermore, clinicians are notoriously inaccurate in predicting life expectancy, with studies frequently showing both over- and underestimating. We developed models with high predictive validity of future mortality in a large sample of older veterans with diabetes.”
To do that, a prevalence sample of 275,190 veterans with diabetes age 65 and older on Jan. 1, 2006, were used. The study team queried databases on potential predictors that included patient demographics, comorbidities, procedure codes, laboratory values and anthropomorphic measurements, medication history and previous health service utilization.
Ultimately, 37 predictors of mortality were identified: four demographic variables, prescriptions for insulin, sulfonylureas, or blood pressure medications, six biomarkers, previous outpatient and inpatient utilization, and 22 comorbidities/procedures. The prognostic indices showed good discrimination, with C-statistics of 0.74 and 0.76 for 5- and 10-year mortality, respectively.
“Prognostic indices obtained from administrative data can predict 5- and 10-year mortality in older adults with diabetes,” the researchers concluded. “Such a tool may enable clinicians and patients to develop individualized treatment goals that balance risks and benefits of treatment intensification.”
“We aren’t saying, for example, that any of these risk factors result in decreased life expectancy,” Griffith added. “However, the more risk factors that individuals have, the greater the risk of higher mortality over time.”
Griffith KN, Prentice JC, Mohr DC, Conlin PR. Predicting 5- and 10-Year Mortality Risk in Older Adults With Diabetes. Diabetes Care 2020 Jun; dc191870.https://doi.org/10.2337/dc19-1870