Disability and Diabetes in Adults

This article reviews findings from national studies of prevalence in diabetes-related disability, presents new data on contemporary trends in disability among people with diabetes across the United States, summarizes risk factors and mechanisms for the excess disability prevalence associated with diabetes, and reviews evidence that disability may be preventable or modifiable. Cross-sectional and prospective studies have consistently found that people with diabetes have 50%–90% increased risk of disability, including mobility loss, reduced instrumental activities of daily living (IADL) and activities of daily living (ADL), and work disability. The association of diabetes with increased disability risk is multifactorial, with age, longer diabetes duration, obesity, coronary heart disease, lower extremity complications, depression, and stroke among the most consistently observed factors explaining the difference in disability rates between people with and without diabetes. Additionally, several studies have suggested that specific physiological factors, including inflammation, insulin resistance, hyperglycemia, and their contribution to loss of muscle mass, may also mediate the higher diabetes-related disability risk. Nationally representative data from 2019–2022 show that 21% of adult women with diabetes (vs. 9% of women without diabetes) and 19% of adult men with diabetes (vs. 7% of men without diabetes) reported any disability. For both women and men with diabetes, the prevalence of any disability increased with age, ranging from ~15% for adults age 20–44 years to ~35%–40% for those age ≥75 years. The relative differences in disability prevalence between persons with versus without diabetes decreased with age. In 2019–2022, one-third of adults with diabetes had mobility disability or some mobility difficulty. Among persons with diabetes, there were substantial differences in disability prevalence according to other sociodemographic factors. Notably, the prevalence of any disability among persons with diabetes living below the poverty threshold (poverty income ratio [PIR] <1.0) was double the prevalence among those living above the poverty threshold (PIR ≥1.0): 34% vs. 17%, respectively. The high prevalence of disability among people with diabetes poses substantial burden to people with diabetes, health care and public health systems, employers, and payors. Lifestyle interventions focused on achieving weight loss and increasing physical activity are effective for reducing disability and long-term functional decline in people with diabetes. However, further research is needed to determine the impact of preventive care and diabetes management practices, including diabetes treatment and the emergence of new diabetes therapies, on disability risk. Continued surveillance is needed to determine the impact of primary and secondary prevention approaches on disability risk in the coming decades.