People With Diabetes May Face Higher Disability Risk
Analysis finds they are roughly 50 percent more likely to have trouble with walking, daily self-care
Wednesday, July 24, 2013
Disability includes trouble walking, using a telephone, managing finances, shopping and even bathing, dressing and eating.
"We found that diabetes increased the risk of disability by 50 percent to 80 percent compared to those without diabetes, and this result was consistent across all types of disability," said review senior author Anna Peeters, head of obesity and population health at Baker IDI Heart and Diabetes Institute in Melbourne, Australia.
"The results of this study are particularly important in the context of an aging population and increasing diabetes prevalence over time," she said. "In combination, this suggests a substantial increase in the burden of disability in the elderly in coming decades."
Peeters said it isn't clear exactly how diabetes contributes to the increased risk of disability, but she did point out that researchers controlled the data to account for other factors that are common to both diabetes and disability, such as obesity and a sedentary lifestyle, and they still found a link between diabetes and disability.
She said it's possible that the inflammation associated with high blood sugar levels may contribute to disability, or it's possible that diabetes complications, such as heart disease, kidney problems and limb amputations, may add to the disability risk.
Results of the study were published online July 23 in the journal The Lancet Diabetes and Endocrinology.
During the past three decades, the incidence of diabetes has more than doubled, according to background information in the review. That means approximately 347 million adults worldwide had diabetes in 2008. Complications of diabetes can include heart disease, vision problems, kidney disease and blood vessel disease in the extremities, according to the review.
Studies looking at the risk of disability in people with diabetes have had mixed results. Some have shown no link, while others have found a doubling of disability risk.
To get a better idea of what the actual risk might be, Peeters and her colleagues reviewed data from 26 studies that compared the risk of disability in people with and without diabetes.
They found that the odds of someone with diabetes having a mobility disability, such as trouble walking, were 71 percent higher than for someone without diabetes. The chances of someone with diabetes having trouble with using the phone, shopping or using transportation were 65 percent higher. And the odds that someone with diabetes would have difficulty with eating, dressing and bathing were 82 percent higher, according to the review.
Peeters said the studies didn't break down diabetes by type, but she said it's likely that most had type 2 diabetes.
In addition, she said, few studies looked at the effect of diabetes management on the risk of disability, so it isn't clear if well-managed diabetes provides protection against disability. She said, however, that in the few studies that looked at diabetes management, poor control of blood sugar levels appeared to increase the risk of disability.
"We know that good control of diabetes decreases the risk of known major complications and those complications are, in turn, associated with future disability," Peeters said. "It is therefore highly likely that good diabetes control will decrease one's risk of disability."
One expert said the findings did not prove a cause-and-effect link between diabetes and an increased risk of disabilities.
"I don't think this study shows a clear connection between diabetes and disability, although it is a good effort in starting to think about the subject and it increases awareness for physicians," said Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. "But there are still many questions to be answered."
Another expert agreed.
For example, the review doesn't look at the differences in disability based on the severity or duration of diabetes, said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.
Zonszein also noted, however, that the study "illustrates, as expected, how diabetes, when not diagnosed and treated properly, can cause disabilities, with a high cost to the patient, the family, society and a burden to the health care system."
"This study adds to others that show, from a public-health-policy perspective, the importance of shifting monies from treating complications and disability to investing in disease prevention, and early diagnosis and treatment," he said.