GUY’S GOTTA TALK ABOUT…TYPE 2 DIABETES #25: Know What LEAD Stands For? [Neither Did I: Life Expectancy Estimator for Older Adults with Diabetes]

For the first time since I started this blog eleven years ago, it’s going to be about me. I was diagnosed with Type 2 Diabetes two weeks ago. While people are happy to talk about their experiences with diabetes, I WASN’T comfortable with talking about diabetes. My wife is Type 2, as are several friends of ours. The “other Type” of diabetes was what caused the death of my Best Man a year after my wife and I got married. He was diagnosed with diabetes when he was a kid. It was called Juvenile Diabetes then. Today it’s Type 1. Since then, I haven’t WANTED to talk about diabetes at all. But…for my own education and maybe helping someone else, and not one to shut up for any known reason, I’m reopening my blog rather than starting a new one. I MAY take a pause and write about Breast Cancer or Alzheimer’s as medical headlines dictate; but this time I’m going to drag anyone along who wants to join my HIGHLY RELUCTANT journey toward better understanding of my life with Type 2 Diabetes. You’re Welcome to join me!

Did you know that there are medical standards of care that doctors can refer to when they’re working with seniors with Type 2 diabetes?

Neither did I.

Also, while the document was JUST revised in December of 2023, there’s an entire section that applies to seniors. One of the early sections had an interesting statement, and I’ll go through the part that applies to me and wife a bit later.

I was startled to find this: “The recommendations and text of Section 5 were adjusted to place focus on guiding the behavior of health care professionals rather than people with diabetes, thus aligning with the purpose of the Standards of Care as guidance for health care professionals.” (13. Older Adults: Standards of Care in Diabetes—2024)

One of the reasons for greater involvement and expected reliance on a person’s health care professional is something I’m SURE all of you are familiar with (if not with the fancy-pants name), “polypharmacy”. Never heard of it ‘til I read this document: “noun: polypharmacy; the simultaneous use of multiple drugs to treat a single ailment or condition; the simultaneous use of multiple drugs by a single patient, for one or more conditions.” I see it as “make sure you put the right pills in the right box so you can take them at the right time!”

I can see that – even though when I was trying to help my mother self-manage the numerous pills she had to take, the freakin’ condition didn’t have a NAME!) Of COURSE I need the advice of my doctor (who isn’t actually a DOCTOR per se, but a Physicians Assistant) to know when to take what I need to take and HOW to take it! Now the American Diabetes Association has made an official recommendation.

Another thing I’ll be talking to my PA about is this: “Notably, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD) tool was developed and validated among older adults with diabetes, and a high-risk score was strongly associated with having a life expectancy of less-than five years.”

The heck is THIS????

Here’s what I found out: “A tool based on data from the electronic health record (EHR) may help clinicians estimate life expectancy in older adults with diabetes, a recent study found. The tool uses gender, body mass index, serum creatinine level, dementia, metastatic cancer, peripheral vascular disease, albuminuria, home oxygen use, wheelchair use, current smoking, and the interaction between age and heart failure to generate a risk score.”


They noted, “The authors noted that their tool…was not validated in patients younger than age 65 years and was less accurate over longer periods (among other limitations.) They also cautioned that the tool's results should be considered in a broader context along with other factors that influence individualized care, such as patient preferences.”

So…why would I get this test if it offers such limited amount of information? (The “conspiracy theorist in me would say, “So insurance companies can deny MORE seniors health care coverage…”) But, I’m CERTAIN that’s not what it would be used for! It’s a tool to…what?

I suppose looking at ALL of those things, would give a doctor or other caregiver different things to both watch for and begin to work on. For example: body mass index – if I knew my BMI was too high, I could certainly start to work to lose weight. Nothing STUPID, but certainly change the fact that I eat a package of OREO Cookie DoubleStufs before bed once a week! I could stop smoking (if I did, but I didn’t, so let’s just go back to eating Oreos); I could get screened for Alzheimer’s (which I do twice a year); I could make sure I exercise regularly to keep my heart strong (I ride about 12-15 miles a week during the summer; and stationary bike 2-5 hours a week in the winter in addition to walking a couple of miles every other day.)

I could have my PA give me the LEAD: Life Expectancy Estimator for Older Adults with Diabetes (LEAD)…which I will when I go in for my shots in a week or so…I’ll report then!

Source: https://diabetesjournals.org/care/article/47/Supplement_1/S244/153944/13-Older-Adults-Standards-of-Care-in-Diabetes-2024; https://diabetesjournals.org/care/article/47/Supplement_1/S5/153943/Summary-of-Revisions-Standards-of-Care-in-Diabetes; 13. Older Adults: Standards of Care in Diabetes—2024 | Diabetes Care | American Diabetes Association (diabetesjournals.org) Image: https://www.hcd.com/wp-content/uploads/2021/01/living-well-with-diabetes.jpg