Risk factors for a 6‐year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese elderly diabetes intervention trial

Abstract

Aim: Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly. Methods:The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively.Results: After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL. Conclusion:This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each

Comparison of body composition and physical and cognitive function between older Japanese adults with no diabetes, prediabetes and diabetes: A cross‐sectional study in community‐dwelling Japanese older people

“…Microvascular injury induced by hyperglycemic damage could progress to the peripheral nerves before patients become aware of any symptoms. Furthermore, latent DPN is known to accrue before symptom manifestation, up to 50% of DPN might be asymptomatic, and DPN has been identified as a risk factor for lower extremity physical disability and functional limitation . The results of the current study are consistent with these findings.…”

“…6 In contrast, diabetes involving episodes of hypoglycemia was also a risk factor for reduced cognitive function and the incidence of dementia. [7][8][9] Previous Japanese research has examined diabetic neuropathy resulting from a decline in physical function in diabetes patients; [10][11][12][13] however, few studies have considered the relationship between diabetes and lower extremity function or compared community-dwelling older adults with and without diabetes. In addition, functional decline in Japanese community-dwelling older adults with diabetes and prediabetes has not been examined sufficiently.…”

Health-related Quality of Life (HRQOL) Decreases Independently of Chronic Conditions and Geriatric Syndromes in Older Adults With Diabetes: The Fujiwara-kyo Study

“…One study found that physical activity could help prevent functional limitations in older diabetic individuals with an average HbA1c of 8.5%. 31 Although the average HbA1c among our diabetes patients was much lower, 6.8%, physical activity could effectively maintain physical function.…”

“…This result agrees with previous findings, which showed that older adults with diabetes had a higher risk of developing physical disability. 30 , 31 Lower PCS can be interpreted as subjective difficulty with activities in everyday life (eg, walking, climbing, bathing), limitations in carrying out work or daily activities, or pain that interferes with work or daily activities. One pathway to low PCS would be the presence of cardiovascular disease and obesity.…”

Effect of Early Diagnosis and Lifestyle Modification on Functional Activities in Community‐Dwelling Elderly Adults with Glucose Intolerance: 5‐Year Longitudinal Study

“…To the Editor : Older people with diabetes mellitus frequently have functional impariment, but there are few reports of the protective effects of longitudinal interventions on functional decline in older people newly diagnosed according to an oral glucose tolerance test (OGTT) . The association between glucose intolerance and decline in instrumental activities of daily living (IADL) was examined to verify the hypothesis that annual education on lifestyle modification can help prevent IADL decline in people with glucose intolerance in a 5‐year longitudinal study.…”