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Diabetes reduces disability-free life-years, increases mortality
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A middle-aged U.S. adult with diabetes will develop a disability 6 to 7 years earlier than an adult without diabetes and spend more years in a disabled state, according to research in Diabetes Care.
In an analysis of national survey data spanning 14 years, researchers found that the associations between diabetes status, disability-free years and disabled years were similar among men and women, with disability differences between diabetic and nondiabetic adults decreasing with age.
“We found that diabetes is associated with a substantial deterioration of nondisabled years, and this is a greater number of years than on the loss of longevity associated with diabetes,” Barbara H. Bardenheier, PhD, MPH, of the division of diabetes translation and the immunization safety office at the CDC, and colleagues wrote.
Bardenheier and colleagues analyzed data from 20,008 adults aged at least 50 years participating in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. The cohort was followed from 1998 to 2012; 14.1% of men and 12.2% of women had diabetes at baseline. Participants self-reported their diabetes and disability status, defined by mobility loss, difficulty with instrumental activities of daily living or difficulty with activities of daily living. Researchers estimated incidence of disability, remission to nondisabled status and mortality, using a discrete-time Markov model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes.
Researchers found that adults with diabetes died 4.6 years earlier, developed disability 6 to 7 years earlier, and spent about 1 to 2 more years in a disabled state than adults without diabetes.
With increasing baseline age, diabetes was associated with significant reductions in the number of total and disability-free life-years (P < .05), but the absolute difference in years between those with and without diabetes was less than at younger baseline age.
Men with diabetes spent about twice as much of their remaining years disabled (20%-24% of remaining life across the three disability definitions) as men without diabetes (12%-16% of remaining life). Women with diabetes spent about 1.5 times as much of their remaining years disabled (27%-32%) than women without diabetes (20%-22%).
The researchers noted that adults with diabetes had considerably higher disability incidence at all ages, leading to a younger age of disability onset and more years spent in a disabled state.
“Once a person with diabetes became disabled, they were less likely to revert to regular functioning, therein increasing the number of years with disability,” the researchers wrote. – by Regina Schaffer
Disclosure: One of the researchers is an employee of Merck.
Perspective
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Evelyn Wong, MBBS, MPH, PhD
We know that diabetes, compared with no diabetes, is associated with a higher risk for disability, measured as limitations to mobility or ability to perform daily activities. Disability is a good indicator of independent living. We can measure one’s healthy life expectancy, which in the context of this study is defined as remaining years lived without disability. From this novel study, we can now appreciate the impact of diabetes on our healthy life expectancy. This is particularly pertinent at a time of increasing trend of diabetes against a backdrop of an aging population. Recent trends of disability in the United States have shown an increase in disability amongst those aged 40 to 64 years. This is cause for concern as this demographic group ages with impact on the population’s productivity, pension schemes, health and aged care resources. With diabetes increasing years lived with disability and decreasing disability-free life expectancy, the impact of diabetes around the retirement age requires close monitoring and further highlights the urgent need for diabetes prevention in young and middle-aged adults.
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