Potentially modifiable factors associated with disability among people with diabetes.
OBJECTIVE
This article seeks to identify potentially modifiable factors associated with disability among people with diabetes.


METHODS
Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work.


RESULTS
Depression was associated with a tenfold increase in elevated WHO-DAS-II and low SF-36 Social Functioning scores, and a fourfold increase in 20+ days of reduced household work. Minor depression and the presence of three or more diabetic complications were associated with approximately a twofold increase in disability risk. Diabetic symptoms, chronic disease comorbidity, and reduced exercise were also associated with disability.


CONCLUSIONS
Among people with diabetes, depression, diabetic complications, and exercise are potentially modifiable factors associated with disability. This suggests that integrated, biopsychosocial approaches may be needed to understand and to ameliorate disability among people with diabetes.
Von Korff
Michael
M
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. vonkorff.m@ghc.org
Katon
Wayne
W
Lin
Elizabeth H B
EH
Simon
Gregory
G
Ludman
Evette
E
Oliver
Malia
M
Ciechanowski
Paul
P
Rutter
Carolyn
C
Bush
Terry
T
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