Association of Diabetes, Comorbidities, and A1C With Functional Disability in Older Adults
Open accessAbstract
OBJECTIVE: To examine the relationship of diabetes and functional disability in older adults and the possible mediating roles of comorbidities and A1C. RESEARCH DESIGN AND METHODS: We analyzed data from a nationally representative sample of 6,097 participants aged ≥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). RESULTS: 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 ≥8%) together explained up to 85% of the excess odds of disability associated with diabetes, whereas poor glycemic control alone explained only ∼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). CONCLUSIONS: 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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Up to 70% of adults with diabetes have difficulty with routine physical tasks, and diabetes is a potent risk factor for most geriatric syndromes.
“Up to 70% of adults with diabetes have difficulty carrying out routine physical tasks, with lower extremity mobility limitations particularly evident, and diabetes is a potent risk factor for most geriatric syndromes.34”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [34]
Part of the mobility reduction in older people with diabetes may be mediated by a direct effect of diabetes on skeletal muscle.
“Although comorbidities—such as cardiovascular disease and obesity—probably contribute to physical disability in diabetes, evidence is emerging that part of the mobility reduction process in older individuals with diabetes is mediated by a direct effect of diabetes on skeletal muscle.34”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [34]
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- Authors
- Kalyani, R. R., Saudek, C. D., Brancati, F. L., & Selvin, E.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Kalyani, Rita Rastogi
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-02-25
- Volume
- 33
- Issue
- 5
- Pages
- 1055-1060
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2858174
- OpenAlex
- W2137138384
- Cited by
- 336
- References
- 26
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 6 · 2023: 12 · 2022: 22 · 2021: 22 · 2020: 25 · 2019: 26 · 2018: 26 · 2017: 24 · 2016: 26 · 2015: 15 · 2014: 45 · 2013: 23 · 2012: 20
- FWCI
- 18.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p60dk079637-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60 DK-079637, K01DK076595, K24DK062222, P30DK079637, R21DK080294, K23DK093583)
- National Center for Research Resources (M01RR000052, KL2RR025006)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- diabetes mellitus, functional disability, older adults, comorbidities, glycemic control, HbA1c, cardiovascular disease, obesity, activities of daily living, instrumental activities of daily living, lower extremity mobility, physical activity, diabetes duration
- MeSH terms
- Activities of Daily Living, Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Disability Evaluation, Female, Glycated Hemoglobin, Humans, Leisure Activities, Male, Motor Activity, Nutrition Surveys, Surveys and Questionnaires, Social Behavior, United States, Comorbidity, Prevalence, Age Distribution
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