title: Diabetes, hyperglycemia, and the burden of functional disability among older adults in a community-based study.
abstract: BACKGROUND
  There is a need for continued surveillance of diabetes-related functional disability. In the present study, we examined associations between diabetes, hyperglycemia, and the burden of functional disability in a community-based population.
  
  
  METHODS
  A cross-sectional analysis was conducted of 5035 participants who attended Visit 5 (2011-13) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self-reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. Associations of diagnosed diabetes (via self-report) and undiagnosed diabetes and prediabetes (via HbA1c) with functional disability were evaluated using Poisson regression.
  
  
  RESULTS
  Participants had a mean age of 75 years, 42 % were male, 22 % were Black, and 31 % had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability than those without diabetes, even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95 % confidence intervals) were 1.24 (1.15, 1.34) for lower extremity mobility, 1.14 (1.07, 1.21) for general physical activities, 1.33 (1.16, 1.52) for instrumental activities of daily living (ADL), and 1.46 (1.24, 1.73) for ADL (all P < 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all P > 0.05).
  
  
  CONCLUSIONS
  Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors, including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.
authors: Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Job G
authors: JG
authors: Godino
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Lawrence J
authors: LJ
authors: Appel
authors: Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Alden L
authors: AL
authors: Gross
authors: Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Jennifer A
authors: JA
authors: Schrack
authors: Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Christina M
authors: CM
authors: Parrinello
authors: The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.|Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Rita R
authors: RR
authors: Kalyani
authors: Division of Geriatric Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
authors: Beverly Gwen
authors: BG
authors: Windham
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors: James S
authors: JS
authors: Pankow
authors: Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors: Stephen B
authors: SB
authors: Kritchevsky
authors: The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.|Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: Karen
authors: K
authors: Bandeen-Roche
authors: Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Elizabeth
authors: E
authors: Selvin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D008297:Male
chemical_list: D001786:Blood Glucose
keywords: Aging; diabetes complications; disability; physical function; prevalence