Objectives To examine the independent association of diabetes (and its duration and severity) with quadriceps strength, quadriceps power, and gait speed in a national population of older adults. Design Cross-sectional nationally representative survey. Setting U.S. Participants We examined 2573 adults ≥50 years of age in the National Health and Nutrition Examination Survey 1999–2002 who had assessment of quadriceps strength. Methods Diabetes was ascertained by questionnaire. Measurement of isokinetic knee extensors (quadriceps) strength was performed at 60 degrees/second. Gait speed was assessed using a 20-foot walk test. Multiple linear regression analyses were used to assess the association between diabetes status and outcomes, adjusting for potential confounders or mediators. Results Among older U.S. adults, those with versus without diabetes had significantly slower gait speed (0.96±0.02 versus 1.08±0.01 m/s; p<0.001). After adjusting for demographics, weight, and height, diabetes was also associated with significantly lower quadriceps strength (−4.6±1.9 Newton-meters; p=0.02), quadriceps power (−4.9±2.0 Watts; p=0.02), in addition to gait speed (−0.05±0.02 m/s; p=0.002). Associations remained significant after adjusting for physical activity and C-reactive protein. After accounting for comorbidities (cardiovascular disease, peripheral neuropathy, amputation, cancer, arthritis, fracture, COPD), diabetes was only independently associated with gait speed (−0.04±0.02 m/s; p=0.02). Diabetes duration in men and women was negatively associated with age-adjusted quadriceps strength (−5.7 and −3.5 Newton-meters/decade of diabetes, respectively) and power (−6.1 and −3.8 Watts/decade of diabetes, respectively) (all p≤0.001, no significant interactions by gender). Hemoglobin A1c was not associated with outcomes accounting for body weight. Conclusion Compared to persons without diabetes, older U.S. adults with diabetes have lower quadriceps strength and quadriceps power that is related to the presence of comorbidities. Persons with diabetes also walk slower. Future studies should investigate the relationship of hyperglycemia with subsequent declines in leg muscle function.

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These findings are consistent with, and extend the findings, of a prior 2004 SCAI survey, in documenting a substantial prevalence of orthopedic complications among active interventional cardiologists, which persists despite increased awareness.

Objective-We conducted a randomized clinical trial examining the effects of modafinil in reducing persistent fatigue in patients following treatment for cancer and performed secondary analyses to assess the effect of modafinil on cognitive function. Methods-Breast cancer patients who reported a score of ≥ 2 on the Brief Fatigue Inventory (BFI) were enrolled in the study. In Phase 1 (P1), patients received 200mg modafinil open-label once daily for 4 weeks. In Phase 2 (P2), patients with a positive response following P1 were randomized either to an additional 4 weeks of modafinil or to placebo. Tests of memory and attention selected from the Cognitive Drug Research (CDR) computerized cognitive assessment were performed at baseline (before modafinil) and after completing Phase 1 and 2. The paired differences for each test score were subjected to a Wilcoxon's signed rank test. Results-Of the 82 women who were enrolled, 76 completed P1 and 68 completed all assessments in the study. Modafinil had a significant effect on the Speed of Memory (p=0.0073) and Quality of Episodic Memory (p<0.0001) during P1 of the study. After randomization at week 8, those patients who continued modafinil demonstrated significantly greater improvement in Speed of Memory (p=0.029), Quality of Episodic Memory (p=0.0151) and mean Continuity of Attention (p=0.0101) relative to the group switched to placebo. Conclusion-We found that modafinil improved cognitive performance in breast cancer survivors by enhancing some memory and attention skills. Although confirmation is needed, these findings suggest that modafinil may enhance quality of life in this patient population.