Physical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms

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.

[1]  J. Adam,et al.  Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. , 2013, Journal of the American Medical Directors Association.

[2]  Paul M Ridker,et al.  Inflammation in atherosclerosis: from pathophysiology to practice. , 2009, Journal of the American College of Cardiology.

[3]  K. Meijer,et al.  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. , 2012, Diabetes research and clinical practice.

[4]  D. Palacios-Ceña,et al.  Trends in the prevalence of physical and functional disability among Spanish elderly suffering from diabetes (2000-2007). , 2011, Diabetes research and clinical practice.

[5]  Elvy Ickowicz.  Guidelines for Improving the Care of the Older Person with Diabetes Mellitus , 2003 .

[6]  L. Ferrucci,et al.  Inflammatory markers and physical performance in older persons: the InCHIANTI study. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  S. Bandinelli,et al.  Role of Muscle Mass and Muscle Quality in the Association Between Diabetes and Gait Speed , 2012, Diabetes Care.

[8]  B. Stuart,et al.  Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. , 2011, The American journal of geriatric pharmacotherapy.

[9]  L. Wray,et al.  Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. , 2011, The Gerontologist.

[10]  L. Lipsitz,et al.  The microvascular frontal-subcortical syndrome of aging , 2002, Neurobiology of Aging.

[11]  D. Williamson,et al.  Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence , 2010, Population health metrics.

[12]  Plamen Nikolov,et al.  Economic Costs of Diabetes in the U.S. in 2002 , 2003, Diabetes care.

[13]  C. Huang,et al.  Diabetes as a risk factor for dementia and mild cognitive impairment: a meta‐analysis of longitudinal studies , 2012, Internal medicine journal.

[14]  J Tuomilehto,et al.  Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius? , 1999, Diabetes care.

[15]  S. Rubin,et al.  Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[16]  L. Ferrucci,et al.  International working group on Sarcopenia , 2011 .

[17]  H. Hazuda,et al.  Better Glycemic Control Is Associated With Maintenance of Lower-Extremity Function Over Time in Mexican American and European American Older Adults With Diabetes , 2011, Diabetes Care.

[18]  S. Kritchevsky,et al.  Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. , 2007, Archives of internal medicine.

[19]  Claudia Stein,et al.  Population health metrics: crucial inputs to the development of evidence for health policy , 2003, Population health metrics.

[20]  Edward H Ip,et al.  Lifestyle change and mobility in obese adults with type 2 diabetes. , 2012, The New England journal of medicine.

[21]  L. Kuller,et al.  Fat Infiltration in Muscle: New Evidence for Familial Clustering and Associations With Diabetes , 2008, Obesity.

[22]  A. LaCroix,et al.  Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. , 1993, American journal of epidemiology.

[23]  J. Cauley,et al.  Diabetes and incidence of functional disability in older women. , 2002, Diabetes care.

[24]  L. Kuller,et al.  Excessive Loss of Skeletal Muscle Mass in Older Adults With Type 2 Diabetes , 2009, Diabetes Care.

[25]  Mohamed Karmali,et al.  Type 2 diabetes mellitus and inflammation: Prospects for biomarkers of risk and nutritional intervention , 2010, Diabetes, metabolic syndrome and obesity : targets and therapy.

[26]  S. Bandinelli,et al.  Impairments of Muscles and Nerves Associated with Peripheral Arterial Disease and Their Relationship with Lower Extremity Functioning: The InCHIANTI Study , 2004, Journal of the American Geriatrics Society.

[27]  J. Barela,et al.  Muscle strength and ankle mobility for the gait parameters in diabetic neuropathies. , 2013, Foot.

[28]  S. Volpato,et al.  Type 2 diabetes and risk for functional decline and disability in older persons. , 2010, Current diabetes reviews.

[29]  F. Andrade,et al.  Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke , 2012, BMC Public Health.

[30]  L. Ferrucci,et al.  Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study. , 2002, Diabetes care.

[31]  Sandrine Andrieu,et al.  Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. , 2011, Journal of the American Medical Directors Association.

[32]  Sei J. Lee,et al.  Glycosylated Hemoglobin and Functional Decline in Community‐Dwelling Nursing Home–Eligible Elderly Adults with Diabetes Mellitus , 2012, Journal of the American Geriatrics Society.

[33]  Christos Davatzikos,et al.  Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy , 2011, The Lancet Neurology.

[34]  L. Wray,et al.  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. , 2011, Diabetes research and clinical practice.

[35]  L. Ferrucci,et al.  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 , 2013, Journal of the American Geriatrics Society.

[36]  Tamara B. Harris,et al.  Diabetes-related complications, glycemic control, and falls in older adults , 2008 .

[37]  L. Hiltunen.  Does glucose tolerance affect elderly persons' balance, gait or muscle strength? , 2001, Central European Journal of Public Health.

[38]  S. Al Snih,et al.  Cross-Sectional Associations of Albuminuria and C-Reactive Protein With Functional Disability in Older Adults With Diabetes , 2011, Diabetes Care.

[39]  M. Chin,et al.  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 , 2008, Annals of Internal Medicine.

[40]  R. Shephard.  Physical Activity Advice Only or Structured Exercise Training and Association With HbA1c Levels in Type 2 Diabetes: A Systematic Review and Meta-analysis , 2012 .

[41]  L. Fried,et al.  Hyperglycemia and Incidence of Frailty and Lower Extremity Mobility Limitations in Older Women , 2012, Journal of the American Geriatrics Society.

[42]  C. Fagour,et al.  Low physical activity in patients with type 2 diabetes: the role of obesity. , 2013, Diabetes & metabolism.

[43]  B. Rajendran.  Impaired fasting glucose versus impaired glucose tolerance. , 2001, The Journal of the Association of Physicians of India.

[44]  L. Fried,et al.  Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk , 1997, Journal of the American Geriatrics Society.

[45]  K. Markides,et al.  The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans. , 2012, Age and ageing.

[46]  R. Malhotra,et al.  Prevalence, correlates and perceived causes of limitations in activities of daily living among older Singaporeans , 2012, Aging Clinical and Experimental Research.

[47]  Michael E. Miller,et al.  Effects of intensive glucose lowering in type 2 diabetes. , 2008, The New England journal of medicine.

[48]  A M Jette,et al.  The disablement process. , 1994, Social science & medicine.

[49]  R. Holman,et al.  Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) , 1998, The Lancet.

[50]  F. Pouwer,et al.  Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis , 2010, Diabetologia.

[51]  Luigi Ferrucci,et al.  Assessing the building blocks of function: utilizing measures of functional limitation. , 2003, American journal of preventive medicine.

[52]  W. Cheung,et al.  Older people with diabetes have higher risk of depression, cognitive and functional impairments: Implications for diabetes services , 2011, The journal of nutrition, health & aging.