Association of Diabetes, Comorbidities, and A1C With Functional Disability in Older Adults Results from the National Health and Nutrition Examination Survey (NHANES), 1999–2006

Division of Endocrinology and Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA. .
Diabetes care (Impact Factor: 8.42). 02/2010; 33(5):1055-60. DOI: 10.2337/dc09-1597
Source: PubMed

ABSTRACT To examine the relationship of diabetes and functional disability in older adults and the possible mediating roles of comorbidities and A1C.
We analyzed data from a nationally representative sample of 6,097 participants aged >or=60 years in the National Health and Nutrition Examination Survey, 1999-2006. Diabetes was defined by self-report. Disability was defined as difficulty performing a physical task. We evaluated disability by grouping 19 physical tasks into five functional groups: lower-extremity mobility (LEM), general physical activities (GPA), activities of daily living (ADL), instrumental activities of daily living (IADL), and leisure and social activities (LSA).
Older U.S. adults with diabetes had the greatest disability in GPA (prevalence 73.6% [95% CI 70.2-76.9]), followed by LEM (52.2% [48.5-55.9]), IADL (43.6% [40.1-47.2]), ADL (37.2% [33.1-41.3]), and LSA groups (33.8% [30.8-36.9]). Diabetes was associated with two to three times increased odds of disability across functional groups (all P < 0.05). Comorbidities, mostly cardiovascular disease and obesity, and poor glycemic control (A1C >or=8%) together explained up to 85% of the excess odds of disability associated with diabetes, whereas poor glycemic control alone explained only approximately 10% of the excess odds. Adjustment for comorbidities, A1C, and diabetes duration fully attenuated the associations of diabetes with disability in all functional groups (all P > 0.05).
Older adults with diabetes have a high prevalence of disabilities with variable associations attributable to comorbidities and A1C. Aggressive management of cardiovascular risk factors and obesity may significantly reduce the burden of disability in this population.

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    • "Previous studies have described high rates of physical function limitations among type 2 diabetics (Kalyani et al., 2010; Gregg et al., 2000), but the relationship between physical disability and prediabetes has not been studied as intensively. In one of the only investigations of physical function in pre-diabetic adults, Lee et al. (2013) found that a high prevalence of physical function limitations among those with pre-diabetes. "
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    ABSTRACT: The prevalence of pre-diabetes (PD) among US adults has increased substantially over the past two decades. By current estimates, over 34% of US adults fall in the PD category, 84% of whom meet the American Diabetes Association's criteria for impaired fasting glucose (IFG). Low physical activity (PA) and/or sedentary behavior are key drivers of hyperglycemia. We examined the relationship between PD and objectively measured PA in NHANES 2003-2006 of 20,470 individuals, including 7,501 individuals between 20 and 65 yrs.We excluded all participants without IFG measures or adequate accelerometry data (final N = 1,317). Participants were identified as PD if FPG was 100-125 mg/dL (5.6-6.9 mmol/L). Moderate and vigorous PA in minutes/day individuals were summed to create the exposure variable "moderate-vigorous PA" (MVPA). The analysis sample included 884 normoglycemic persons and 433 with PD. There were significantly fewer PD subjects in the middle (30.3%) and highest (24.6%) tertiles of PA compared to the lowest tertile (35.5%). After adjusting for BMI, participants were 0.77 times as likely to be PD if they were in the highest tertile compared to the lowest PA tertile (p < 0.001). However, these results were no longer significant when age and BMI were held constant. Univariate analysis revealed that physical activity was associated with decreased fasting glucose of 0.5 mg/dL per minute of MVPA, but multivariate analysis adjusting for age and BMI was not significant. Overall, our data suggest a negative association between measures of PA and the prevalence of PD in middle-aged US adults independent of adiposity, but with significant confounding influence from measures of BMI and age.
    PeerJ 08/2014; 2(Suppl 1):e499. DOI:10.7717/peerj.499 · 2.11 Impact Factor
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    • "Similar to other studies [3], participants were defined as having peripheral neuropathy if the examination (using a standard monofilament [5.07 Semmes-Weinstein nylon monofilament]) determined at least 1 insensate area in either foot, which is predictive of ulcers and amputations and has demonstrated high sensitivity and specificity [27]. Participants were considered to have a functional disability if they reported special assistance for walking (e.g., cane), had limitations that prevented them from working, or reported having any difficulty in the five functional disability categories reported elsewhere [28]. Lastly, a binary variable was created with participants classified as taking medications if they self-reported taking insulin, diabetic pills, blood pressure-lowering medication, cholesterol-lowering medication, or anticoagulants. "
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    ABSTRACT: Background Although much is known about the management of peripheral arterial disease among adults in the general population, the management of this disease among those with diabetes, and the effects of diabetic-induced peripheral arterial disease on objectively-measured physical activity, is unclear. Here, we examined the association between accelerometer-assessed physical activity and peripheral arterial disease among a national sample of U.S. adults with diabetes. Methods Data from the 2003–2004 National Health and Nutrition Examination Survey were used. Physical activity was measured using an accelerometer in 254 adults with diabetes. Peripheral arterial disease was assessed via ankle brachial index. Negative binomial regression analysis was used to examine the association between physical activity and peripheral arterial disease. Results Results were adjusted for age, gender, race-ethnicity, comorbidity index, smoking, HgbA1C, C-reactive protein, homocysteine, glomerular filtration rate, microalbuminuria, peripheral neuropathy, physical functioning, and medication use. After adjustments, participants with peripheral arterial disease engaged in 23% less physical activity (RR = 0.77, 95% CI: 0.62-0.96) than those without peripheral arterial disease. Conclusions These findings demonstrate an inverse association between accelerometer-assessed physical activity and peripheral arterial disease in a national sample of U.S adults with diabetes.
    Journal of Diabetes and Metabolic Disorders 05/2014; 13(1):63. DOI:10.1186/2251-6581-13-63
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    • "T2DM can be independently associated with various aging phenotypes collectively defined as “geriatric syndromes” [11,52-57]. These geriatric conditions should be referred to as a third category of diabetic complications [58] and include cognitive impairment and dementia [55,59-67], depression [68,69], reduced muscle strength and quality [70-72], disability [73-77], falls and fall-related morbidity [78,79], as well as urinary incontinence [80]. These clinical conditions are very frequent in older diabetic people, especially in the frail ones. "
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    ABSTRACT: Type 2 diabetes mellitus (T2DM) is one of the most common chronic disorders in older adults and the number of elderly diabetic subjects is growing worldwide. Nonetheless, the diagnosis of T2DM in elderly population is often missed or delayed until an acute metabolic emergency occurs. Accumulating evidence suggests that both aging and environmental factors contribute to the high prevalence of diabetes in the elderly. Clinical management of T2DM in elderly subjects presents unique challenges because of the multifaceted geriatric scenario. Diabetes significantly lowers the chances of "successful" aging, notably it increases functional limitations and impairs quality of life. In this regard, older diabetic patients have a high burden of comorbidities, diabetes-related complications, physical disability, cognitive impairment and malnutrition, and they are more susceptible to the complications of dysglycemia and polypharmacy. Several national and international organizations have delivered guidelines to implement optimal therapy in older diabetic patients based on individualized treatment goals. This means appreciation of the heterogeneity of the disease as generated by life expectancy, functional reserve, social support, as well as personal preference. This paper will review current treatments for achieving glycemic targets in elderly diabetic patients, and discuss the potential role of emerging treatments in this patient population.
    Aging 03/2014; 6(3):187-206. · 6.43 Impact Factor
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