Comorbidities and Impairments Explaining the Association Between Diabetes and Lower Extremity Disability

Volpato, Stefano; Blaum, Caroline S.; Resnick, Helaine E.; Ferrucci, Luigi; Fried, Linda P.; Guralnik, Jack M.

doi:10.2337/diacare.25.4.678

Cited by 190 publications

(182 citation statements)

References 27 publications

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“…Reasons for this effect are not clear. Findings from an earlier study showed a 100–150% increased incidence of disability among older women with diabetes compared to non-diabetic age peers [46]. Indeed, women with diabetes had a 78% increased risk of mobility-related disability and a 65% higher risk of activities of daily living (ADL) disability [47].…”

Section: Discussionmentioning

confidence: 99%

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

Werfalli

Kassanjee

Kalula

et al. 2018

Global Health Action

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Background: Diabetes is a chronic disease with severe late complications. It is known to impact the quality of life and cause disability, which may affect an individual’s capacity to manage and maintain longer-term health and well-being. Objectives: To examine the prevalence of self-report diabetes, and association between diabetes and each of health-related quality of life and disability amongst South Africa’s older adults. To study both the direct relationship between diabetes and these two measures, as well as moderation effects, i.e. whether associations between other factors and these measures of well-being differed between individuals with diabetes and those without. Methods: Secondary analyses of data on participants aged 50 years and older from the Study on global AGEing and adult health (SAGE) in South Africa Wave 1 (2007–2008) were conducted. Prevalence of self-reported diabetes was assessed. Multivariable regressions describe the relationships between each of quality of life (WHOQoL) and disability (WHODAS), and diabetes, while controlling for selected socio-demographic characteristics, health risk behaviours and co-morbid conditions. In the regression models, we also investigated whether diabetes moderates the relationships between these additional factors and WHOQoL/WHODAS. Results: Self-reported diabetes prevalence was 9.2% (95% CI: 7.8,10.9) and increased with age. Having diabetes was associated with poorer WHOQoL scores (additive effect: −4.2; 95% CI: −9.2,0.9; p-value <0.001) and greater disability (multiplicative effect: 2.1; 95% CI: 1.5,2.9; p-value <0.001). Lower quality of life and greater disability were both related to not being in a relationship, lower education, less wealth, lower physical activity and a larger number of chronic conditions. Conclusions: Diabetes is associated with lower quality of life and greater disability amongst older South Africans. Attention needs to be given to enhancing the capacity of health systems to meet the changing needs of ageing populations with diabetes in SA as well as facilitating social support networks in communities.

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Section: Discussionmentioning

confidence: 99%

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

Werfalli

Kassanjee

Kalula

et al. 2018

Global Health Action

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“…This is a matter of concern, because previous studies have shown that impairments in physical functioning of the lower extremities are independent predictors of loss of autonomy [3,4,8]. Diabetes is often accompanied by vascular and neurological disorders, as well as depressive symptoms and dementia, but these cannot explain completely the increased risk of disability.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have focused on difficulties encountered with activities of daily living (ADL), because they are strong predictors of morbidity and mortality [2,3,4]. The objective of this paper is to assess the burden of disability in a sample of older Italians with diabetes, and the role of comorbidity and diabetic complications in determining disability.…”

Section: Introductionmentioning

confidence: 99%

Physical disability among older Italians with diabetes. The ILSA Study

et al. 2004

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Aims/hypothesis. We studied the role of diabetic complications and comorbidity in the association between diabetes and disability in the elderly. Methods. Data were from a nationally representative sample of 5632 older Italians, aged 65 years and older, and who participated in the Italian Longitudinal Study on Aging. Clinical diagnoses of diabetes and other major chronic conditions were made by a physician, while disability was assessed by self-reported information on activities of daily living and physical performance tests. Results. After adjusting for age, education and BMI, disability on the basis of activities of daily living was associated with diabetes in women, but not in men (odds ratio [OR] 1.65, CI: 1.22-2.23 and OR 1.21, CI: 0.84-1.75 respectively). In contrast, the association between severe and/or total disability on the basis of physical performance tests and diabetes was strong in both sexes (OR 2.81, CI: 1.44-5.41 and OR 2.16, CI: 1.25-3.73 respectively). Adjusting for traditional complications and comorbidity reduced the excess odds of disability by 38% in women and by 16% in men. Conclusions/interpretation. Disability in older Italians with diabetes is frequent and only partially attributable to traditional diabetic complications and comorbidity.

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“…Diabetic polyneuropathy is an important factor in the development of peripheral muscle weakness in diabetes patients (10). The associated loss of muscle strength is an underestimated but disabling problem (9) that has been associated with impaired physical function (11) and poor glycemic control (12).…”

Section: Discussionmentioning

confidence: 99%

“…The latter is partly due to the many difficulties encountered when trying to define an appropriate exercise programme for these patients, who generally suffer from substantial weight gain (5), exercise intolerance and diabetic polyneuropathy (6)(7)(8). The level of diabetic polyneuropathy also appears to be associated with general muscle weakness (9,10), impaired physical performance (11), poor glycemic control (12) and a high cardiovascular risk profile (13). As clinical evidence for the health benefits of exercise intervention is quite scarce in this diabetes subpopulation, many patients are generally not advised to participate in intense endurance exercise intervention programmes.…”

Section: Introductionmentioning

confidence: 99%

Long-standing, insulin-treated type 2 diabetes patients with complications respond well to short-term resistance and interval exercise training

Praet¹,

Jonkers²,

Schep³

et al. 2008

European Journal of Endocrinology

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Objective: To determine the feasibility and the benefits of combined resistance and interval exercise training on phenotype characteristics and skeletal muscle function in deconditioned, type 2 diabetes (T2D) patients with polyneuropathy. Design: Short-term, single-arm intervention trial. Methods: Eleven male T2D patients (age: 59.1G7.5 years; body mass index: 32.2G4.0 kg/m 2 ) performed progressive resistance and interval exercise training thrice a week for 10 weeks. Besides primary diabetes outcome measures, muscle strength (MUST), maximal workload capacity (W max ), whole-body peak oxygen uptake (VO 2peak ) and muscle oxidative capacity (MUOX), intramyocellular lipid (IMCL) and glycogen (IMCG) storage, and systemic inflammation markers were determined before and after training. Daily exogenous insulin requirements (EIR) and historic individualized EIR were gathered and analysed. Results: MUST and W max increased with 17% (90% confidence intervals 9-24%) and 14% (6-21) respectively. Furthermore, mean arterial blood pressure declined with 5.5 mmHg (K9.7 to K1.4). EIR dropped with 5.0 IU/d (K11.5 to 1.5) compared with baseline. A decline of respectively K0.7 mmol/l (K2.9 to 1.5) and K147 mmol/l (K296 to 2) in fasting plasma glucose and non-esterified fatty acids concentrations were observed following the intervention, but these were not accompanied by changes in VO 2peak , MUOX, IMCL or IMCG, and blood glycolysated haemoglobin, adiponectin, tumor necrosis factor-a and/or cholesterol concentrations. Conclusion: Short-term resistance and interval exercise training is feasible in deconditioned T2D patients with polyneuropathy and accompanied by moderate improvements in muscle function and blood pressure. Such a specific exercise regimen may provide a better framework for future exercise intervention programmes in the treatment of deconditioned T2D patients.

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Comorbidities and Impairments Explaining the Association Between Diabetes and Lower Extremity Disability

Cited by 190 publications

References 27 publications

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

Physical disability among older Italians with diabetes. The ILSA Study

Long-standing, insulin-treated type 2 diabetes patients with complications respond well to short-term resistance and interval exercise training

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