Individualized HbA1c treatment goals for older aldults with diabetes mellitus

• Applicant: Privatdozent Dr. Ben Schöttker
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Epidemiology and Medical Biometry/Statistics
• Term: from 2014 to 2016
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 271269462

The current version of the German national guideline for the treatment of type 2 diabetes mellitus from the year 2013 recommends, among other things, to individualize HbA1c treatment goals by age and co-morbidity but does not state concrete reference values to be used as an orientation for care givers. Up to date, studies addressing this research question are lacking nationally and internationally. The goal of this grant application is to conduct the preparatory work to set up a consortium of ageing cohorts aiming for concrete recommendations for individualized HbA1c treatment goals in older adults with diabetes mellitus. The preparatory work can be done with already collected data from the ESTHER and DIANA cohort studies, which are conducted by the German Cancer Research Center and comprise altogether 2,466 individuals with diabetes mellitus in the age range 50-84 years. The preparatory work shall only identify a global HbA1c treatment goal for older adults with diabetes mellitus, which may be higher than the one for younger diabetics. It can be assumed that higher HbA1c treatment goals lead to less frequent hypoglycemias and a higher quality of life. An accumulation of deficits index (ADI) will be chosen as the outcome for the analyses because maintaining functional abilities is more important than preventing single diabetes co-morbidities in this age group with a limited life expectancy. Because of sample size limitations, analyses in the ESTHER and DIANA cohort cannot be conducted stratified by patient characteristics that could be useful to individualize the global HbA1c treatment goal. This shall be the objective of the consortium in a follow up project. However, the testing for effect modification by patient characteristics with respect to the association of HbA1c and changes of the ADI will already be possible and shall be done in the ESTHER and DIANA study to provide the ground for a sample size calculation for the consortium. The sample size of older adults with diabetes mellitus in the consortium shall be sufficient to estimate HbA1c reference values groups stratified by all relevant patient characteristics. The following patient characteristics will be assessed: Age, sex, education, life-style factors, co-morbidity, frailty and diabetes duration. Finally, it will be described, how often and for what reasons individualized HbA1c treatment goals are already applied in the German primary care setting and to quantify the discrepancy with the results of this project. This final investigation, which has high relevance for the care of older diabetes patients, shall estimate the demand for interventions that could result from the overall project.

• DFG Programme: Research Grants
• Co-Investigators: Professor Dr. Hermann Brenner; Professorin Dr. Ute Mons