Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.
Diabetes Care. 2021 Mar;44(3):690-698. doi: 10.2337/dc20-2232. Epub 2021 Jan 14.
Diabetes is linked to functional decline, but the impact of prediabetes on physical function is unknown. We aimed to examine and compare the impact of prediabetes and diabetes on physical function and disability progression and to explore whether cardiovascular diseases (CVDs) mediate these associations.
A cohort of 2,013 participants aged ≥60 from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing population-based longitudinal study, was monitored for up to 12 years. Physical function was measured with chair stand (s) and walking speed (m/s) tests, and disability was measured by summing the numbers of impaired basic and instrumental activities of daily living. Diabetes was identified through medical examinations or clinical records, medication use, or glycated hemoglobin (HbA) ≥6.5%. Prediabetes was defined as HbA ≥5.7-6.4% in participants free of diabetes. CVDs were ascertained through clinical examinations and the National Patient Register. Data were analyzed using mixed-effect models and mediation models.
At baseline, 650 (32.3%) had prediabetes and 151 had diabetes (7.5%). In multiadjusted mixed-effect models, prediabetes was associated with an increased chair stand time (β 0.33, 95% CI 0.05-0.61), a decreased walking speed (β -0.006, 95% CI -0.010 to -0.002), and an accelerated disability progression (β 0.05, 95% CI 0.01-0.08), even after controlling for the future development of diabetes. Diabetes led to faster functional decline than prediabetes. In mediation analyses, CVDs mediated 7.1%, 7.8%, and 20.9% of the associations between prediabetes and chair stand, walking speed, and disability progression, respectively.
Prediabetes, in addition to diabetes, is associated with faster functional decline and disability, independent of the future development of diabetes. This association may be in part mediated by CVDs.
糖尿病与功能下降有关，但前驱糖尿病对身体功能的影响尚不清楚。我们旨在检查和比较前驱糖尿病和糖尿病对身体功能和残疾进展的影响，并探讨心血管疾病（CVDs）是否会调节这些关联。
一项来自瑞典 Kungsholmen 老龄化和护理国家研究的队列研究，共纳入了 2013 名年龄≥60 岁的参与者，这是一项正在进行的基于人群的纵向研究。通过椅子站立（s）和行走速度（m/s）测试来测量身体功能，通过汇总基本和工具性日常生活活动受损的数量来衡量残疾。糖尿病是通过体检或临床记录、药物使用或糖化血红蛋白（HbA）≥6.5%来确定的。前驱糖尿病定义为 HbA 在无糖尿病的参与者中≥5.7-6.4%。CVD 通过临床检查和国家患者登记确定。使用混合效应模型和中介模型进行数据分析。
基线时，650 人（32.3%）患有前驱糖尿病，151 人患有糖尿病（7.5%）。在多调整混合效应模型中，前驱糖尿病与椅子站立时间增加（β 0.33，95%CI 0.05-0.61）、行走速度降低（β-0.006，95%CI-0.010 至-0.002）和残疾进展加速（β 0.05，95%CI 0.01-0.08）相关，即使在控制未来糖尿病发展的情况下也是如此。与前驱糖尿病相比，糖尿病导致更快的功能下降。在中介分析中，CVDs 分别介导了前驱糖尿病与椅子站立、行走速度和残疾进展之间关联的 7.1%、7.8%和 20.9%。
除了糖尿病之外，前驱糖尿病还与更快的功能下降和残疾有关，这与未来糖尿病的发展无关。这种关联部分可能是由 CVDs 介导的。
