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Physical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms

  • Diabetes Epidemiology (SH Golden, Section Editor)
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Abstract

Diabetes mellitus is a common chronic condition worldwide, especially in the elderly population. Several epidemiologic studies in the last 2 years have consistently associated diabetes with physical disability, a condition that may profoundly affect the quality of life of older people. Although in older people with diabetes, the pathogenesis of functional limitation and disability has not been completely elucidated, it is certainly complex and involves multiple potential pathways. In this narrative review, we described the most recent epidemiologic and clinical evidence supporting the association between diabetes and impaired physical function in older persons focusing on emerging biological mechanisms explaining the excess risk of disability associated with diabetes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. International Diabetes Federation (IDF). The Global Burden: Diabetes. Available at: http://www.idf.org/diabetesatlas/5e/Update2012. Accessed April 30, 2013.

  2. •• Volpato S, Maraldi C, Fellin R. Type 2 diabetes and risk for functional decline and disability in older persons. Curr Diabetes Rev. 2010;6:134–43. An exhaustive review defining the nature of the relationship between diabetes and physical disability.

    Article  PubMed  Google Scholar 

  3. Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology and risk. J Am Geriatr Soc. 1997;45:92–100.

    PubMed  CAS  Google Scholar 

  4. U.S. Centers for Disease Control and Prevention. Diabetes data & trends: percentage by age of civilian, noninstitutionalized persons with diagnosed diabetes, United States, 1980–2011. Available at: http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.html. Accessed April 30, 2013.

  5. • Economic costs of diabetes in the U.S. in 2012. American Diabetes Association. Diabetes Care. 2013;36:1033–46. This paper estimates the economic impact of diabetes in the U.S.

    Article  Google Scholar 

  6. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics. 2010;22:8–29.

    Google Scholar 

  7. Shaw J, Zimmet P, de Courten M, Dowse G, Chitson P, Gareeboo H, et al. Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius? Diabetes Care. 1999;22:399–402.

    Article  PubMed  CAS  Google Scholar 

  8. Hiltunen LA. Does glucose tolerance affect elderly persons’ balance, gait or muscle strength? Cent Eur J Public Health. 2001;9:22–5.

    PubMed  CAS  Google Scholar 

  9. Verbrugge LM, Jette AM. The disablement process. Soc Sci Med. 1994;38:1–14.

    Article  PubMed  CAS  Google Scholar 

  10. Guralnik JM, Ferrucci L. Assessing the building blocks of function: utilizing measures of functional limitation. Am J Prev Med. 2003;25:112–21.

    Article  PubMed  Google Scholar 

  11. Chiu CJ, Wray LA. Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. Gerontologist. 2011;51:51–63.

    Article  PubMed  Google Scholar 

  12. •• Volpato S, Bianchi L, Lauretani F, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012;35:1672–9. This study found that older people with diabetes have higher muscle mass, lower muscle strength, worse muscle quality, and slower gait speed compared with participants without diabetes.

    Article  PubMed  Google Scholar 

  13. Izerman TH, Schaper NC, Melai T, Meijer K, Willems PJ, Savelberg HH. Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes Res Clin Pract. 2012;95:345–51.

    Article  Google Scholar 

  14. Kalyani RR, Tra Y, Yeh HC, Egan JM, Ferrucci L, Brancati FL. Quadriceps strength, quadriceps power, and gait speed in older U.S. adults with diabetes mellitus: results from the National Health and Nutrition Examination Survey, 1999–2002. J Am Geriatr Soc. 2013. [Epub ahead of print].

  15. Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013 [Epub ahead of print].

  16. Guralnik JM, LaCroix AZ, Abbott RD, et al. Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol. 1993;137:845–57.

    PubMed  CAS  Google Scholar 

  17. Gregg EW, Mangione CM, Cauley JA, et al. Diabetes and incidence of functional disability in older women. Diabetes Care. 2002;25:61–7.

    Article  PubMed  Google Scholar 

  18. Andrade FC, Guevara PE, Lebrão ML, Duarte YA. Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke. BMC Publ Health. 2012;12:361.

    Article  Google Scholar 

  19. Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik JM. Comorbidities and impairments explaining the association between diabetes and lower extremity disability: the women's health and aging study. Diabetes Care. 2002;25:678–83.

    Article  PubMed  Google Scholar 

  20. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65. Erratum, Lancet 1998;352:1558.

    Article  Google Scholar 

  21. Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med. 2008;149:11–9.

    Article  PubMed  Google Scholar 

  22. • Kalyani RR, Tian J, Xue QL, Walston J, Cappola AR, Fried LP, et al. Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women. J Am Geriatr Soc. 2012;60:1701–7. This paper clearly demonstrates that higher levels of glycated hemoglobin are associated with development of poor physical performance.

    Article  PubMed  Google Scholar 

  23. Wang CP, Hazuda HP. Better glycemic control is associated with maintenance of lower-extremity function over time. Diabetes Care. 2011;34:268–73.

    Article  PubMed  Google Scholar 

  24. • Yau CK, Eng C, Cenzer IS, Boscardin WJ, Rice-Trumble K, et al. Glycosylated hemoglobin and functional decline in community-dwelling nursing home–eligible elderly adults with diabetes mellitus. J Am Geriatr Soc. 2012;60:1215–21. This paper introduced a controversy regarding the effects of pursuing very low glucose levels in older diabetic patients.

    Article  PubMed  Google Scholar 

  25. Schwartz AV, Vittinghoff E, Sellmeyer DE, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.

    Article  PubMed  Google Scholar 

  26. Launer LJ, Miller ME, Williamson JD, Lazar RM, Gerstein HC, Murray AM, et al. ACCORD MIND investigators. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomized open-label substudy. Lancet Neurol. 2011;10:969–77.

    Article  PubMed  Google Scholar 

  27. Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB, et al. Action to control cardiovascular risk in diabetes study group, Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.

    Article  PubMed  CAS  Google Scholar 

  28. Brown AF, Mangione CM, Saliba D, et al. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;5(Suppl Guidelines):265–80.

    Google Scholar 

  29. • Fielding R, Vellas B, Evans W, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc. 2011;12:249–56. This paper provides new data on the definition, prevalence, etiology, and consequences of Sarcopenia.

    Article  PubMed  Google Scholar 

  30. •• Park SW, Goodpaster BH, Lee JS, et al. Health, aging, and body composition study. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care. 2009;1993–7. This is one of the first papers in which type 2 diabetes has been associated with excessive loss of skeletal muscle mass in community-dwelling older adults overtime.

  31. Martinelli AR, Mantovani AM, Nozabieli AJ, Ferreira DM, Barela JA, Camargo MR, et al. Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. Foot. 2013;23:317–21.

    Article  Google Scholar 

  32. McDermott MM, Guralnik JM, Albay M, Bandinelli S, Miniati B, Ferrucci L. Impairments of muscles and nerves associated with peripheral arterial disease and their relationship with lower extremity functioning: the InCHIANTI study. J Am Geriatr Soc. 2004;52:405–10.

    Article  PubMed  Google Scholar 

  33. Miljkovic-Gacic I, Wang X, Kammerer CM, Gordon CL, Bunker CH, Kuller LH, et al. Fat infiltration in muscle: new evidence for familial clustering and associations with diabetes. Obesity. 2008;16:1854–60.

    Article  PubMed  Google Scholar 

  34. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005;60:324–33.

    Article  PubMed  Google Scholar 

  35. Badawi A, Klip A, Haddad P, Cole DE, Bailo BG, El-Sohey A, et al. Type 2 diabetes mellitus and inflammation: prospects for biomarkers of risk and nutritional intervention. Diabetes Metab Syndr Obes. 2010;3:173–86.

    Article  PubMed  CAS  Google Scholar 

  36. Kuo HK, Al Snih S, Kuo YF, Raji MA. Cross-sectional associations of albuminuria and C-reactive protein with functional disability in older adults with diabetes. Diabetes Care. 2011;34:710–7.

    Article  PubMed  CAS  Google Scholar 

  37. Palmer RF, Espino DV, Dergance JM, Becho J, Markides K. The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans. Age Ageing. 2012;41:752–8.

    Article  PubMed  Google Scholar 

  38. • Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, et al. Look AHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366:1209–17. An important outcome paper from Look AHEAD showing that lifestyle intervention appears to impact the loss of mobility in people with type 2 diabetes.

    Article  PubMed  CAS  Google Scholar 

  39. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9.

    Article  PubMed  CAS  Google Scholar 

  40. Fagour C, Gonzalez C, Pezzino S, Florenty S, Rosette-Narece M, Gin H, et al. Low physical activity in patients with type 2 diabetes: the role of obesity. Diabetes & Metabolism. 2013;39:85–7.

    Article  CAS  Google Scholar 

  41. Cesari M, Penninx BW, Pahor M, Lauretani F, Corsi AM, Williams GR, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI Study. J Gerontol. 2004;59:242–8.

    Article  Google Scholar 

  42. Libby P, Ridker PM, Hansson GK. Leducq Transatlantic Network on atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129–38.

    Article  PubMed  CAS  Google Scholar 

  43. Pugh KG, Lipsitz LA. The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging. 2002;23:421–31.

    Article  PubMed  Google Scholar 

  44. Maraldi C, Volpato S, Penninx BW, Yaffe K, Simonsick EM, Strotmeyer ES, et al. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med. 2007;167:1137–44.

    Article  PubMed  Google Scholar 

  45. Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42:484–91.

    Article  PubMed  CAS  Google Scholar 

  46. Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, et al. European Depression in Diabetes (EDID) Research Consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53:2480–6.

    Article  PubMed  CAS  Google Scholar 

  47. Malhotra C, Chan A, Malhotra R, Ostbye T. Prevalence, correlates and perceived causes of limitations in activities of daily living among older Singaporeans. Aging Clin Exp Res. 2012;24:56–61.

    Article  PubMed  Google Scholar 

  48. Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother. 2011;9:212–23.

    Article  PubMed  Google Scholar 

  49. Chiu CJ, Wray LA, Ofstedal MB. Diabetes-related change in physical disability from midlife to older adulthood: evidence from 1996–2003. Survey of health and living status of the elderly in Taiwan. Diabetes Res Clin Pract. 2011;91:413–23.

    Article  PubMed  Google Scholar 

  50. Martinez-Huedo MA, Hernandez-Barrera V, Palacios-Ceña D, Carrasco-Garrido P, Hernandez DM, Jiménez-Garcia R. Trends in the prevalence of physical and functional disability among Spanish elderly suffering from diabetes (2000–2007). Diabetes Res Clin Pract. 2011;94:30–3.

    Article  Google Scholar 

  51. Chau PH, Woo J, Lee CH, et al. Older people with diabetes have higher risk of depression, cognitive and functional impairments: implications for diabetes services. J Nutrit Health Aging. 2011;15:751–5.

    Article  CAS  Google Scholar 

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Lara Bianchi declares that she has no conflicts of interest. Giovanni Zuliani declares that he has no conflicts of interest. Stefano Volpato declares that he has no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Stefano Volpato.

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Bianchi, L., Zuliani, G. & Volpato, S. Physical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms. Curr Diab Rep 13, 824–830 (2013). https://doi.org/10.1007/s11892-013-0424-6

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