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Title: Diagnosis of type 2 diabetes in older age : Investigation of mortality, morbidity, illness perceptions and quality of life
Author: Barnett, Karen Nicola
ISNI:       0000 0004 2678 1087
Awarding Body: University of Dundee
Current Institution: University of Dundee
Date of Award: 2009
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Background: The incidence and prevalence of type 2 diabetes is increasing in all age groups but is particularly high in older people. Older people with type 2 diabetes are a growing but neglected population who have been systematically excluded from most major trials and as a result are currently being treated according to guidelines developed for younger people. They are actually a heterogeneous group consisting both of newly diagnosed patients and of patients who have entered into older age already diagnosed with diabetes. Patients diagnosed with type 2 diabetes aged > 65 years account for more than half of all newly diagnosed cases. Despite this, the effect of age at diagnosis on clinical and non clinical outcomes associated with type 2 diabetes is under-explored. Objective: The main focus of this thesis is to compare the consequences of type 2 diabetes when it is diagnosed among younger and older patients. Design: A large retrospective cohort study using routine data available for Tayside, Scotland was carried out to investigate mortality and morbidity. 10,532 patients newly diagnosed with type 2 diabetes and 21,056 non diabetic patients were followed up between 1993 and 2004. A postal questionnaire study was also administered to those patients newly diagnosed in 2004 to investigate whether the effect of type 2 diabetes on illness perceptions and quality of life also differed by age at diagnosis. Results: The absolute risk of all-cause and cardiovascular mortality increased with age at diagnosis. In contrast, the increased risk of mortality when compared to non diabetic counterparts decreased with age at diagnosis. Similar trends were observed for morbidity. Patients diagnosed in older age had only a marginal increased risk of mortality compared to matched non diabetic patients. The increased risk of morbidity was much higher. The questionnaire study suggested that patients diagnosed in older age were less concerned about xv their diabetes and less affected emotionally than patients diagnosed at a younger age. Impact on quality of life was less marked in patients diagnosed in older age but these results were not statistically significant. Conclusion: The consequences associated with a diagnosis of type 2 diabetes were shown to differ by age at diagnosis. A diagnosis of type 2 diabetes in older age is associated with increased mortality and morbidity, but increased risk of morbidity is more pronounced. There were also observable differences in illness perceptions and quality of life.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available