title: Potentially modifiable factors associated with disability among people with diabetes.
abstract: 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.
authors.affiliation: Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. vonkorff.m@ghc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Terry
authors.initials: T
authors.lastname: Bush
mesh_terms: D000203:Activities of Daily Living; D015992:Body Mass Index; D015897:Comorbidity; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology