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Diabetes Care 25:678-683, 2002
© 2002 by the American Diabetes Association, Inc.

Epidemiology/Health Services/Psychosocial Research
Original Article

Comorbidities and Impairments Explaining the Association Between Diabetes and Lower Extremity Disability

The Women’s Health and Aging Study

Stefano Volpato, MD, MPH1,2, Caroline Blaum, MD3, Helaine Resnick, PHD4, Luigi Ferrucci, MD, PHD1,5, Linda P. Fried, MD, MPH3 and Jack M. Guralnik, MD, PHD1

1 Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
2 Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
3 Departments of Medicine and Epidemiology, the Johns Hopkins Medical Institutions, Baltimore, Maryland
4 MedStar Research Institute, Washington, DC
5 Geriatric Department, "I Fraticini," Italian National Institute for Research and Care on Aging (INRCA), Florence, Italy

OBJECTIVE—To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women.

RESEARCH DESIGN AND METHODS—Cross-sectional analysis of 1,002 women (aged >=65 years) enrolled in the Women’s Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures.

RESULTS—Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12–3.06), activities of daily living disability (1.61, 1.06–2.43), and severe walking limitation (2.34, 1.56–3.50), and their summary mobility performance score (0–12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree.

CONCLUSIONS—Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

Abbreviations: ADL, activities of daily living • OR, odds ratio • PAD, peripheral artery disease • PND, peripheral nerve dysfunction


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Copyright © 2002 by the American Diabetes Association.