title: Diabetes and risk of physical disability in adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk.
  
  
  METHODS
  We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability-as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility-in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]).
  
  
  RESULTS
  Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1.71, 95% CI 1.53-1.91; RR 1.51, 95% CI 1.38-1.64), of IADL disability (ten studies; OR 1.65, 95% CI 1.55-1.74), and of ADL disability (16 studies; OR 1.82, 95% CI 1.63-2.04; RR 1.82, 95% CI 1.40-2.36).
  
  
  CONCLUSIONS
  Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes.
  
  
  BACKGROUND
  Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: evelyn.wong@bakeridi.edu.au.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wong
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Backholer
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Gearon
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Harding
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Rosanne
authors.initials: R
authors.lastname: Freak-Poli
authors.affiliation: School of Health and Social Development, Deakin University, Burwood, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stevenson
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Peeters
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D006801:Humans; D012307:Risk Factors; D014938:Work Capacity Evaluation