This chapter reviews findings from national studies of prevention of and trends in diabetes-related disability, summarizes the modifiable risk factors and mechanisms for the excess disability prevalence associated with diabetes, and reviews evidence that physical disability can be prevented or modified.
Cross-sectional and prospective studies have consistently found persons with diabetes to have 50%–90% increased risk of several domains of disability, including mobility loss, reduced instrumental activities of daily living (IADL) or basic activities of daily living (ADL), and work disability. The association of diabetes with increased disability risk is likely multifactorial, with obesity, coronary heart disease, lower extremity diseases, depression, and stroke among the most consistently observed factors explaining the difference in disability risk between people with and without diabetes. Additionally, several studies have suggested that specific physiological factors, including inflammation, insulin resistance, hyperglycemia, and sarcopenia, may also mediate the higher diabetes-related disability risk.
In nationally representative analyses conducted for Diabetes in America, 3rd edition, 40% of diabetic women and 25% of diabetic men reported major mobility disability, about one-fourth of diabetic adults reported work disability, and one-tenth reported IADL disability. When disability prevalence was expressed as either disability or impairments, more than one-third of men were impacted in work (36%) and mobility (44%), almost one-fourth (23%) were impacted in IADL, and 14% were impacted in ADL. Among older adults (ages 65–74 and ≥75 years), prevalences of mobility disability, IADL, and work disability were generally similar among those with normal glucose, prediabetes, and undiagnosed diabetes but were appreciably higher among those with diagnosed diabetes. Among middle-aged adults (age 45–64 years), the association between glucose classification and disability risk was more continuous, with successively higher disability prevalences across those with normal glucose, prediabetes, undiagnosed diabetes, diabetes duration <15 years, and duration ≥15 years. The percentage of adults with diagnosed diabetes reporting limitations in mobility, IADL, and ADL tended to decline between 1997 and 2000 but remained largely unchanged between 2000 and 2011 for all age strata. The percentage of diabetic adults reporting work disability declined from 23.8% in 1997 to a low of 17.9% in 2006, increasing to 19.7% in 2011.
Lifestyle interventions, including weight loss with physical activity, have emerged as particularly promising approaches to reduce diabetes-related disability. However, further research is needed to determine the impact of other preventive care and diabetes management practices on disability risk, and continued surveillance is needed to determine the impact of primary and secondary prevention approaches on disability risk in the coming decades.