Evidence map›Paper›PMID 37254010›Full record

ArticleJournal of general internal medicine2023

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

Andrew J Karter, Melissa M Parker, Howard H Moffet, Kasia J Lipska, Neda Laiteerapong, Richard W Grant, Catherine Lee, Elbert S Huang

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 11 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Andrew J KarterDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA. Andy.j.karter@kp.org.
Melissa M ParkerDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Howard H MoffetDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Kasia J LipskaSection of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Neda LaiteerapongSection of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
Richard W GrantDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Catherine LeeDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Elbert S HuangSection of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
Kaiser Permanente · USUniversity of Chicago · USYale University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Pilot Program CoreP30ES027792 · NIEHS · UNIVERSITY OF CHICAGO · PI Gokhan M. Mutlu, Gail S Prins · 2017 to 2026
$13.6M
Research Design, Data, and Analytics CoreP30DK092949 · NIDDK · UNIVERSITY OF CHICAGO · PI Ronald T. Ackermann, MARSHALL H CHIN · 2011 to 2026
$10.0M
Translational Research Core - Health Engagement & Action Translational (HEAT)P30DK092924 · NIDDK · KAISER FOUNDATION RESEARCH INSTITUTE · PI Alyce Sophia Adams, HILARY Kessler SELIGMAN · 2011 to 2026
$9.2M
My Diabetes My CommunityR01DK127961 · NIDDK · UNIVERSITY OF CHICAGO · PI HUANG, ELBERT S., LINDAU, STACY TESSLER · 2020 to 2020
$5.4M
Optimizing Medical Decision Making for Older Patients with Type 2 DiabetesR01AG063391 · NIA · KAISER FOUNDATION RESEARCH INSTITUTE · PI HUANG, ELBERT S., KARTER, ANDREW JOHN · 2019 to 2023
$3.2M
Preferences, Management, and Outcomes in the Oldest Patients with DiabetesR56AG051683 · NIA · KAISER FOUNDATION RESEARCH INSTITUTE · PI HUANG, ELBERT S., KARTER, ANDREW JOHN · 2016 to 2016
$773k
Research and Mentorship in Medical Decision Making for Chronic Diseases of Older AdultsK24AG069080 · NIA · UNIVERSITY OF CHICAGO · PI HUANG, ELBERT S. · 2020 to 2024
$583k
NCATS NIH HHS UL1 TR001863NIA NIH HHS K24 AG069080NIA NIH HHS R01 AG063391NIA NIH HHS R56 AG051683NIDDK NIH HHS P30 DK092924NIDDK NIH HHS P30 DK092949NIDDK NIH HHS R01 DK127961NIEHS NIH HHS P30 ES027792
6 · The paper itself

Abstract

backgroundEstimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed.

objectiveDevelop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy.

designPredictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort.

participantsAdults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020). MAIN MEASURES: Demographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality. KEY

resultsIn the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration.

conclusionsLEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation.

Indexed as

Diabetes MellitusAgedAgingFemaleHumansLife ExpectancyMaleRetrospective StudiesRisk Factors

Identifiers

PMID37254010
PMCPMC10228886
OpenAlexW4378783177

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.