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Health Sciences' Zhang is Author of Award-Winning Paper

Old Dominion University health economist Qi "Harry" Zhang is one of the authors of an article about diabetes treatments for the elderly that has won the Best Published Research Article of the Year Award from the Society of General Internal Medicine (SGIM).

"The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis" appeared last year in Annals of Internal Medicine of the American College of Physicians. The award will be presented in May at the 32nd Annual Meeting of the SGIM in Miami.

Elbert Huang, a medical doctor and researcher at the University of Chicago, is the first author and Zhang is the second author. Three other researchers also contributed to the article.

Andrew Balas, dean of ODU's College of Health Sciences where Zhang is an assistant professor of community and environmental health, noted that the article's publication in one of the most prestigious journals in the medical field was a fine accomplishment for the authors. "But being selected the best among all articles is a truly outstanding recognition," he said. "The SGIM is an international organization and quite influential in the medical field."

Zhang and his colleagues took on a topic that has received little scientific evaluation. Extensive research has shown that intensive control of glucose in the blood of diabetics can decrease the risk for multiple complications as compared to moderate glucose control. But despite its demonstrated benefits overall, intensive glucose control for older type 2 diabetic patients, and especially those with additional illnesses and other conditions that might limit life expectancy, has remained a subject for debate.

Some medical organizations have endorsed a guideline suggesting that glucose control levels should be tied to life expectancy. Under this concept, patients whose life expectancy is less than five years are considered unlikely to benefit from intensive glucose control.

Comorbid illness in a diabetic, which may be cancer or some other disease, and functional status, which can refer to a wide range of physical, mental or emotional impairments, are well-known determinants of life expectancy, the article states. "(H)owever, the extent to which these characteristics influence the expected benefits of intensive glucose control is unknown," according to the authors.

The researchers used existing clinical evidence and took advantage of recent advances in prediction models in diabetes and geriatrics to evaluate how comorbid illnesses and functional status may alter the expected benefits of intensive glucose control in older type 2 diabetic patients.

"Our results show that limited life expectancy is an important determinant of the expected benefit of intensive glucose control compared with moderate glucose control, even among patients with longstanding diabetes," the article states. "The results suggest that five years of life expectancy is an acceptable threshold for identifying older patients who are unlikely to benefit from intensive control. We found that patients with a life expectancy of five years or less would probably gain only 20 quality-adjusted days with intensive glucose control."

Furthermore, the researchers found that a combination of multiple comorbid illnesses and functional impairments is a more important predictor than age alone of limited life expectancy and diminishing benefits of intensive glucose control.

This article was posted on: April 22, 2009

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