Volpato Stefano, Blaum Caroline, Resnick Helaine, Ferrucci Luigi, Fried Linda P, Guralnik Jack M
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland 20892, USA.
Diabetes Care. 2002 Apr;25(4):678-83. doi: 10.2337/diacare.25.4.678.
To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women.
Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women's Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures.
Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree.
Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.
为阐明糖尿病相关损伤及合并症在糖尿病与身体残疾之间关联中的作用，本研究在一组残疾老年女性样本中考察了糖尿病与下肢功能之间的关联。
对纳入女性健康与衰老研究的1002名女性（年龄≥65岁）进行横断面分析（占社区居住总人口中残疾程度最高的三分之一）。糖尿病及其他疾病状况通过使用多种信息来源的标准进行确定。功能状态通过自我报告和客观表现测量进行评估。
糖尿病女性更有可能患有心血管疾病、周围神经功能障碍、视力损害、肥胖症和抑郁症。在调整年龄后，糖尿病女性在行动能力残疾（比值比[OR]1.85，95%置信区间1.12 - 3.06）、日常生活活动残疾（1.61，1.06 - 2.43）和严重步行受限（2.34，1.56 - 3.50）方面的患病率更高，并且她们的综合行动能力表现评分（基于平衡、步态速度、从椅子上站起的0 - 12分制）比非糖尿病女性低1.4分（P < 0.001）。外周动脉疾病、周围神经功能障碍和抑郁症是主要的个体促成因素；然而，这些状况单独均不能完全解释糖尿病与残疾之间的关联。相反，仅在对所有潜在中介因素进行调整后，糖尿病与残疾之间的关系才在很大程度上减弱。
即使在身体有损伤的老年女性中，糖尿病也与严重的残疾负担相关。多种损伤及合并症解释了糖尿病与残疾之间的关系，表明这种关联的机制是多因素的。
