Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.
J Diabetes. 2017 Jan;9(1):76-84. doi: 10.1111/1753-0407.12386. Epub 2016 Mar 23.
There is a need for continued surveillance of diabetes-related functional disability. In the present study, we examined associations between diabetes, hyperglycemia, and the burden of functional disability in a community-based population.
A cross-sectional analysis was conducted of 5035 participants who attended Visit 5 (2011-13) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self-reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. Associations of diagnosed diabetes (via self-report) and undiagnosed diabetes and prediabetes (via HbA1c) with functional disability were evaluated using Poisson regression.
Participants had a mean age of 75 years, 42 % were male, 22 % were Black, and 31 % had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability than those without diabetes, even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95 % confidence intervals) were 1.24 (1.15, 1.34) for lower extremity mobility, 1.14 (1.07, 1.21) for general physical activities, 1.33 (1.16, 1.52) for instrumental activities of daily living (ADL), and 1.46 (1.24, 1.73) for ADL (all P < 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all P > 0.05).
Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors, including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.
需要持续监测与糖尿病相关的功能障碍。在本研究中，我们在一个基于社区的人群中检查了糖尿病、高血糖与功能障碍负担之间的关联。
对参加动脉粥样硬化风险社区研究第 5 次访视（2011-2013 年）的 5035 名参与者进行了横断面分析。功能障碍通过任何自我报告的难以执行 12 项独立生活基本任务来进行二分法定义，这些任务分为四个功能域。通过 Poisson 回归评估通过自我报告诊断的糖尿病（通过自我报告）和未诊断的糖尿病和糖尿病前期（通过 HbA1c）与功能障碍的关联。
参与者的平均年龄为 75 岁，42%为男性，22%为黑人，31%患有诊断出的糖尿病。与没有糖尿病的人相比，患有诊断出的糖尿病的人有更大的功能障碍负担，即使在调整了人口统计学、健康行为和合并症后也是如此：下肢活动的患病率比（95%置信区间）为 1.24（1.15，1.34），一般身体活动为 1.14（1.07，1.21），日常活动的工具性活动为 1.33（1.16，1.52），日常生活活动为 1.46（1.24，1.73）（均 P<0.05）。未诊断的糖尿病和糖尿病前期与残疾的关联没有统计学意义（均 P>0.05）。
在老年人中，与糖尿病相关的功能障碍负担不能完全用已知的危险因素（包括合并症）来解释。低于糖尿病诊断阈值的高血糖与残疾无关。需要研究针对有糖尿病的老年人预防功能障碍的有效策略。
