Diabetes, hyperglycemia, and the burden of functional disability among older adults in a community‐based study

Abstract

BACKGROUND There is a need for continued surveillance of diabetes-related functional disability. We examined associations between diabetes, hyperglycemia, and the burden of functional disability in a community-based population. METHODS We conducted a cross-sectional analysis of 5,035 participants who attended visit 5 (2011–2013) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self-reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. We evaluated associations of diagnosed diabetes (via self-report), and undiagnosed diabetes and prediabetes (via HbA1c), with functional disability using Poisson regression. RESULTS Participants had a mean age of 75 years, 42% were male, 22% were black, and 31% had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability compared to those without diabetes even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95% CIs) were 1.24 (1.15, 1.34) for lower extremity mobility; 1.14 (1.07, 1.21) for general physical activities; 1.33 (1.16, 1.52) for instrumental activities of daily living; and 1.46 (1.24, 1.73) for activities of daily living (all P < 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all P < 0.05). CONCLUSIONS Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.

Global disability burden and its predictors among adult Nigerians living with Type- 2 diabetes

“…Our result that a unit increase in HbA1c and SBP corresponds to 6.2% and 0.5% respective increase in global disability suggests that people with T2DM, poor BP and glycaemic control are at high risk of burden of global disability. These observations are in agreement with previous report that T2DM with co-morbid conditions and poor glycaemic control (defined by HbA1c ≥ 7.0%) had a higher prevalence of functional disability 7,12. Indeed, all patients with T2DM require close monitoring in terms of health education, adjusted lifestyle assistance and lifestyle management to reduce disease burden.…”

“…One month increase in DM duration has estimated 1.001 times more disability reported in agreement with previous study which observed an association between duration of DM and functional disability. The reported prevalence of functional disability is said to be increasing by approximately 1.3% every year for T2DM 7. Sequelae of ageing process are likely to add to the burden of global disability among people with T2DM as suggested by our data.…”

“…Those studies reported higher prevalence of disability (50.0% – 80.0%) or risk of developing new disability in terms of functioning after diagnosis of T2DM compared with people without T2DM. It is postulated that untreated hyperglycaemia may activate the inflammatory pathway and lead to loss of muscle mass, strength and efficiency, particularly in the lower extremities, which in turn decrease mobility and participation in routine activities and thus aggravate the onset of global disability 7…”

Dynapenic obesity: A disregarded disease that affects functionality and nutrition of the older patients

“…Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into practical strategies for the prevention of functional disability among older adults with diabetes is needed [28]. In our study, fasting blood glucose and HbA1c levels were in near normal ranges and similar in groups.…”

Comparative Effectiveness for Glycemic Control in Older Adults with Diabetes

“…In a study of 5,035 U.S. community-dwelling adults (mean age 75 years), those with diagnosed diabetes and poor glycemic control (defined as HbA1c >7.0%) had a significantly greater prevalence of functional disability in crude and adjusted (for demographics, health behaviors, and comorbidities) models. 51 Among U.S. community-dwelling women aged 70–79 at baseline, HbA1c ≥ 8.0% (compared to <5.5%) was associated with an increased risk of developing walking difficulty (HR=3.47,1.26–9.55) low walking speed (HR=2.82,1.19–6.71), and low physical performance (HR=3.60,1.52–8.53) during an average follow-up of 8+ years. 52 Significant associations have also been found between elevated HbA1c levels and lower lean body mass, as well as lower muscle strength.…”