IT'S A MATTER OF EDUCATION FOR THE
ELDERLY WITH DIABETES

Steven Infanti

By age 75, at least one out of five elderly Americans has diabetes, and the fact that about half of all people with diabetes are over age 60 reflects the increased prevalence of this disease that occurs with advancing age.

However, most elderly persons with diabetes either aren't aware or are not being informed about the importance of dietary management strategies for control of diabetes. That's just one finding of an ongoing study led by Dr. Frank Ahern, senior research scientist in the Department of Biobehavioral Health, and Dr. Helen Smiciklas-Wright, professor of nutrition in the Department of Nutrition.

Ahern and Wright are just two of the college's faculty taking part in an on-going interdisciplinary research project examining drug-food interactions among the elderly. The researchers are working with Dr. Carol Gold of the Department of Biobehavioral Health; and Dr. Rebecca Corwin, Kristie Lancaster, Diane Mitchell, and Lindsay-Rae Weitzel of the Department of Nutrition. The project is under the direction of Lynn McGillin of the Maggee Rehabilitation Hospital in Philadelphia. Another co-investigator on the study is Dr. Debra Heller of Health Services Corporation in Philadelphia.

"Compliance with drugs and treatments such as diet, weight management, and exercise is essential for successful management of type 2 diabetes and prevention of its consequences," explains Ahern. "Although many adults with diabetes practice some appropriate care strategies, remarkably few follow all recommendations of the American Diabetes Association."

There is a lack of adequate knowledge about drug-food interactions and other health promoting behaviors among elderly persons using antidiabetics, says Ahern. The researchers are part of the Medication Safety Program Partnership (MSP), which is assessing and reducing risks related to drug-food interactions among the elderly. In addition to food-drug interactions among elderly diabetics, the MSP is researching risks among elderly users of anticoagulants, medications with appetite suppressant effects, and antihypertensives.

"This is a very critical area that needs to be studied because nutritional status and eating behaviors play a significant role in the clinical effects of prescription drugs," says Wright. For example, Wright notes, dairy products or green leafy vegetables may alter the effects of certain drugs. Certain drugs can have significant effects on eating behaviors and, when used chronically, may greatly affect nutritional status and health. Drugs that may cause nausea or reduce appetite may lead to eating avoidance. Long term use of drugs that stimulate appetite may lead to weight gain and its attendant complications. The use of alcohol or tobacco products with prescription drugs is also known to increase the risk of adverse effects of drugs.

"Despite the large amount of clinical literature on the importance of specific drug-food interaction, little is known regarding those risks among the elderly. Information on the extent and importance of food-drug risks is needed in order to develp effective screening procedures and to develop appropriate risk-reduction interventions," says Ahern.

The Medication Safety Program is funded in part by the Community Partnership of SmithKline Beecham, one of the world's leading healthcare companies. The Medication Safety Program was developed as part of SmithKline Beecham's Community Partnership programs. The MSP was implemented in 1998 as an active partnership with several Pennsylvania organizations: Penn State; Magee Rehabilitation Hospital in Philadelphia; the Pennsylvania Department of Aging; First Health Services Corporation; the Philadelphia Corporation for Aging; MCP Hahnemann University in Philadelphia; the Pharmaceutical Assistance Contract for the Elderly (PACE) Program; and Sessa and Associates, a private-sector consulting firm focused on critical health information.

Diabetes was identified as a key area for investigation by the MSP because elderly persons with diabetes experience multiple diet-related risks, says Wright. The research is ground breaking because most studies on diabetes and its health consequences have focused on younger subjects. These preliminary results of risk indicators for elderly persons with diabetes suggest that there is a need for more patient education on risks associated with diabetes.

"The study makes a strong case for interventions targeted to obese diabetics. We found that nearly 50 percent of elderly persons in the study taking antidiabetic agents are obese. This suggests that this group should be singled out as the most worthy of early targeted intervention," says Ahern.

Less than 25 percent of the subjects in the study were following a diet to lose weight and only about one-third reported participating in any physical activity in the past month.

"Our results indicate that many obese elderly persons with diabetes reported that they were not advised to lose weight as part of their diabetes care, suggesting that health care professionals are simply reluctant or unskilled, or both, with respect to advising their patients about this topic," says Wright. "Further, although one half of respondents said that they were advised by a health professional to lose weight, only about one quarter reported being on a weight loss diet. That finding suggests that many elderly do not understand the importance of, or do not feel they are able to make dietary and lifestyle modifications to control their weight."

Among the researchers' other findings: Less than 40 percent of individuals on anti-diabetic medications reported that they knew certain foods could affect how well some medicines work. Only 1 out of 5 knew that certain foods could cause problems with the particular medicines they were taking. One out of 5 reported that their doctors or pharmacists did not make recommendations about eating behaviors for their medicines. Only 1 in 10 received information from dietitians. About 1 in 4 did not know that they're supposed to avoid alcohol when taking their medicines.

"It is clear that many subjects in this study are not following the lifestyle modifications for individuals with diabetes. It is also clear that health professionals should provide more attention to learning the skills required to give more salient and effective dietary recommendations, and to make weight management a priority for their obese patients with diabetes," says Ahern.

When funds are available, the co-investigators will initiate the third phase of the Medication Safety Program. This intervention and demonstration phase will target physician-prescribers, pharmacist-providers and consumers of medications with high risk of drug-food interactions. The planned interventions will be fielded within two large-scale systems that provide health benefits to elderly Pennsylvanians: The PACE program, and the Geisinger Health System. These sites are model systems for provision of pharmaceutical benefits and reduction of risks associated with medication use. The interventions that work in these systems can be tailored for other third-party pharmaceutical benefit programs and HMOs.