|
1
|
Munshi MN, Venditti EM, Tjaden AH, Knowler WC, Boyko EJ, Middelbeek RJW, Luchsinger JA, Lee CG, Hazuda HP, Salive ME, Edelstein SL, Storer TW. Long-term impact of Diabetes Prevention Program interventions on walking endurance. Front Public Health 2024; 12:1470035. [PMID: 39744353 PMCID: PMC11688401 DOI: 10.3389/fpubh.2024.1470035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/27/2024] [Indexed: 01/18/2025] Open
Abstract
Objectives Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. We aimed to examine the long-term effects of metformin or intensive lifestyle intervention in adults at high risk of T2D on their 6-min walk test (6MWT) performance. Methods Participants were randomized in the 3-year Diabetes Prevention Program (DPP) to one of the three groups: lifestyle intervention, metformin, or placebo, and were subsequently followed in the DPP Outcomes Study. A 6MWT was conducted 20 years after randomization. Associations between DPP interventions and 6MWT completion (achieving a distance ≥200 m) were assessed using logistic regression. Among the test completers, differences in distance walked (6MWD) were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of body mass index (BMI) and grip strength along with mean measures of HbA1c and self-reported physical activity (PA). Results Data on 1830 participants were analyzed. The interventions were not associated with test completion or the 6MWD among test completers (362, 364, and 360 m in the lifestyle, metformin, and placebo groups, respectively, p = 0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and the 6MWD after adjustment. Grip strength, PA, and education were positively associated with the 6MWD, while age, BMI, and HbA1c were negatively associated with the 6MWD. Conclusion We confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle. However, we did not observe a sustained effect of the original randomized interventions. Clinical trial registration http://www.clinicaltrials.gov/ct/show/NCT00004992, identifier DPP NCT00004992; http://www.clinicaltrials.gov/ct/show/NCT00038727, identifier DPPOS NCT00038727.
Collapse
Affiliation(s)
- Medha N Munshi
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ashley H Tjaden
- DPP/DPPOS Coordinating Center, The Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States
| | - William C Knowler
- DPP/DPPOS Coordinating Center, Biostatistics Center (Consultant), The George Washington University, Rockville, MD, United States
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound, Seattle, WA, United States
| | - Roeland J W Middelbeek
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Christine G Lee
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, United States
| | - Helen P Hazuda
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Marcel E Salive
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, MD, United States
| | - Sharon L Edelstein
- DPP/DPPOS Coordinating Center, The Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States
| | - Thomas W Storer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
|
2
|
Toth EE, Vujić A, Ihász F, Ruíz-Barquín R, Szabo A. A Fullerton Functional Fitness Test-based exercise intervention for older adults yields quick physical and psychological benefits. Complement Ther Clin Pract 2024; 57:101880. [PMID: 38968691 DOI: 10.1016/j.ctcp.2024.101880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES Functional fitness is essential for healthy living in older adults. Specially targeted fitness programs might be the most beneficial. This intervention study aimed to assess the efficacy of a specific 16-week exercise program in improving functions as measured by the Fullerton Functional Fitness Test (FFFT), also known as the Senior Test, in older adults. PARTICIPANTS Thirty-eight participants (66 % women, Mage = 80.15, SD = 7.21) were randomized into an exercise group (n = 24) and a waiting list control group (n = 14). The exercise group trained three times a week for 1 h. METHODS Objective tests (FFFT and handgrip power) and subjective psychological measures (life satisfaction, resilience, happiness, perceived stress, and well-being) were obtained at baseline, after eight weeks, and after 16 weeks. The data were analyzed using mixed-effect regression models. RESULTS The results yielded statistically significant group-by-time interactions in all models, indicating improvements in physical and psychological measures over time in the treatment group compared to the control group. Significant differences between the groups in the estimated marginal means (with adjusted 95 % confidence intervals) emerged after 16 weeks in happiness (-3.5 [-6.5, -0.4]), resilience (-5.5 [-9.9, -1.2]), perceived stress (2.2 [0.2, 4.2]), well-being (-5.8 [-7.9, -3.6]), upper limb strength (-5.7 [-9.0, -2.4]), upper body flexibility (-8.7 [-16.4, -1.0]), and agility and balance (4.6 [1.2, 8.1]). Except for happiness and resilience, these differences surfaced already after eight weeks. CONCLUSION The here-employed 16-week exercise program, targeting the test elements of the FFFT, efficiently induced physical and mental improvements in older adults.
Collapse
Affiliation(s)
- Eliza E Toth
- Doctoral School of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Aleksandar Vujić
- Doctoral School of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Ihász
- Institute of Sport Science, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Szombathely, Hungary
| | - Roberto Ruíz-Barquín
- Facultad de Formación de Profesorado y Educación, Universidad Autónoma de Madrid, Madrid, Spain
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| |
Collapse
|
|
3
|
Lee CH, Chen YA, Yang CM, Huang KH, Tsai TH, Chang Y, Shieh SH. Risk Factors Associated with Unplanned Hospitalization Among Long-Term Care Facility Residents: A Retrospective Study in Central Taiwan. Healthcare (Basel) 2024; 12:2069. [PMID: 39451485 PMCID: PMC11507413 DOI: 10.3390/healthcare12202069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 10/04/2024] [Accepted: 10/12/2024] [Indexed: 10/26/2024] Open
Abstract
Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21-1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02-1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03-1.33) and renal failure (OR = 1.63, 95% CI = 1.42-1.86), high fall risk (OR = 2.67, 95% CI = 2.30-3.10), and being bedridden (OR = 6.55, 95% CI = 5.48-7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15-2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally.
Collapse
Affiliation(s)
- Chiu-Hsiang Lee
- School of Nursing, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yu-An Chen
- Department of Education, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Chiu-Ming Yang
- Department of Health Services Administration, China Medical University, Taichung 406, Taiwan; (C.-M.Y.); (K.-H.H.); (T.-H.T.)
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung 406, Taiwan; (C.-M.Y.); (K.-H.H.); (T.-H.T.)
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung 406, Taiwan; (C.-M.Y.); (K.-H.H.); (T.-H.T.)
| | - Yuanmay Chang
- Institute of Long-Term Care, Mackay Medical College, New Taipei City 252, Taiwan;
| | - Shwn-Huey Shieh
- Department of Health Services Administration, China Medical University, Taichung 406, Taiwan; (C.-M.Y.); (K.-H.H.); (T.-H.T.)
- Department of Nursing, China Medical University Hospital, Taichung 406, Taiwan
- Department of Nursing, Asia University, Taichung 413, Taiwan
| |
Collapse
|
|
4
|
Albalawi HFA. The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review. Healthcare (Basel) 2024; 12:917. [PMID: 38727474 PMCID: PMC11083061 DOI: 10.3390/healthcare12090917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution. OBJECTIVE This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes. RESULTS Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise. CONCLUSIONS Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.
Collapse
Affiliation(s)
- Hani Fahad A Albalawi
- Department of Health Rehabilitation Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| |
Collapse
|
|
5
|
Janssen SM, Connelly DM, Gillis H. Educators' Perspectives on the Teaching and Learning of Type 2 Diabetes Content in Physiotherapy Programmes across Canada. Physiother Can 2024; 76:46-54. [PMID: 38465311 PMCID: PMC10919371 DOI: 10.3138/ptc-2021-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/25/2022] [Accepted: 02/26/2022] [Indexed: 03/12/2024]
Abstract
Purpose This qualitative descriptive study researched educators' perspectives of type 2 diabetes (T2D) Teaching and learning, in physiotherapy (PT) programmes across Canada. Methods Faculty members and clinical instructors from the 15 PT programmes in Canada were contacted. Online surveys collected data on the educators' professional background and perspectives on T2D in the PT curriculum. One-on-one telephone interviews were conducted and thematic analysis was used to generate themes and codes from the interview transcripts. Results Ten educators from 10 universities completed the survey. Seven of the 10 educators also participated in a telephone interview. Survey responses revealed that T2D content is taught predominantly through case studies and lectures. Of the 10 respondents, six reported that the curriculum does not devote adequate time to T2D content, and nine reported they "strongly agree" or "agree" that T2D is an essential component of the PT curriculum. The interviews revealed that T2D content varies across PT programmes. The educators agreed that T2D is a common condition seen in practice, there is a role for PT intervention, and T2D content is limited by classroom time. Conclusions Educators noted challenges integrating more T2D content in the curriculum and said that PT clinical contributions for people living with T2D are underutilized. Additional evidence-informed rationale is needed to explore optimal integration of T2D content in PT programmes.
Collapse
Affiliation(s)
- Sarah M. Janssen
- From the:Health and Rehabilitation Sciences Graduate Program, Western University, London, Ontario, Canada
| | | | - Heather Gillis
- School of Physical Therapy, Western University, London, Ontario, Canada
| |
Collapse
|
|
6
|
Takahashi N, Tsubota-Utsugi M, Takahashi S, Yonekura Y, Ohsawa M, Kuribayashi T, Onoda T, Takanashi N, Sakata K, Yamada T, Ogasawara K, Omama S, Tanaka F, Asahi K, Ishigaki Y, Itabashi R, Itamochi H, Takahashi F, Okayama A, Tanno K. Sex- and Age-Specific Associations Between Metabolic Syndrome and Future Functional Disability in the Japanese Older Population. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241273103. [PMID: 39183635 PMCID: PMC11348345 DOI: 10.1177/00469580241273103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 08/27/2024]
Abstract
Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akira Okayama
- The Research Institute of Strategy for Prevention, Tokyo, Japan
| | | |
Collapse
|
|
7
|
Tsai YH, Chuang LL, Lee YJ, Chiu CJ. Behavioral and Psychological Factors in Buffering Diabetes-related Disability Development. Ann Behav Med 2023; 57:1046-1057. [PMID: 37549141 DOI: 10.1093/abm/kaad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Diabetes is associated with disability development. Healthy behaviors and psychosocial support can help patients manage their disease. PURPOSE To examine the role of various behavioral and psychological factors in buffering the effect of diabetes on disability development over time in Taiwanese adults. METHODS Data on 5,131 adults aged ≥50 years were obtained from the Taiwan Longitudinal Study on Aging. A cohort sequential multilevel design was employed to analyze the association between behavioral and psychosocial factors and the risk of disability over a 11-year period. RESULTS In patients with diabetes, having social support and exercising more than six times a week were associated with 4% and 49% reductions in the risk of disability, respectively (βdiabetes*socialsupport = -0.285, p = .006; βdiabetes*exercise3 = -2.612, p = .007). Exercising more than six times a week had an additional significant protective effect against disability development per year (βdiabetes*exercises3*age = -0.241, p = .038). Depression did not significantly interact with diabetes. However, a trajectory analysis revealed that individuals who had both diabetes and depression had the highest disability score from middle age among all participants. CONCLUSIONS Engaging in frequent exercise is the most influential factor for reducing the risk of disability in patients with diabetes. Social support provides an additional benefit for disability prevention in individuals with diabetes.
Collapse
Affiliation(s)
- Yi-Hsuan Tsai
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Lun Chuang
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Yau-Jiunn Lee
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
|
8
|
Formiga F, Badía-Tejero AM, Corsonello A, Ärnlöv J, Carlsson AC, Mattace-Raso F, Tap L, Kostka T, Guligowska A, Sieber CC, Kob R, Ben-Romano R, Yehoshua I, Roller-Wirnsberger R, Wirnsberger GH, Fabbietti P, Lattanzio F, Moreno-González R. Diabetes and factors associated with cognitive and functional decline. The screening for CKD among older people across Europe (SCOPE) study. Aging Clin Exp Res 2023; 35:2693-2701. [PMID: 37668841 DOI: 10.1007/s40520-023-02536-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without. AIMS Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants. METHODS A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored. RESULTS Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42-7.56), history of stroke (OR 4.58, 95% CI 1.64-12.7), and greater IADL dependency (OR 1.08 95% CI 1.02-1.15). DISCUSSION Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related. CONCLUSION Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population.
Collapse
Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana María Badía-Tejero
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Corsonello
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology (IRCCS INRCA), National Institute of Health and Science on Ageing, Cosenza, Ancona, Italy
| | - Johan Ärnlöv
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisanne Tap
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Łódź, Hallera 1, 90-647, Łódź, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Łódź, Hallera 1, 90-647, Łódź, Poland
| | - Cornel C Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Ronit Ben-Romano
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Maccabi Health Organization, Negev District, Beersheba, Israel
| | - Ilan Yehoshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Maccabi Health Organization, Negev District, Beersheba, Israel
| | | | | | - Paolo Fabbietti
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology (IRCCS INRCA), National Institute of Health and Science on Ageing, Cosenza, Ancona, Italy.
| | | | - Rafael Moreno-González
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
|
9
|
Bruce DG, Davis WA, Davis TME. Group-Based Trajectory Modelling of Changes in Mobility over Six Years in Type 2 Diabetes: The Fremantle Diabetes Study Phase II. J Clin Med 2023; 12:4528. [PMID: 37445563 DOI: 10.3390/jcm12134528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
To investigate temporal changes in mobility in community-based people with type 2 diabetes, Fremantle Diabetes Study Phase II (FDS2) data were analysed. The baseline assessment included the Timed Up and Go (TUG) test, which was repeated biennially for up to six years. Group-based trajectory modelling (GBTM) identified TUG trajectory groups in participants with ≥2 tests. Independent associates of group membership were assessed using multinomial regression. Of 1551 potential FDS2 participants, 1116 (72.0%; age 64.9 ± 11.0 years, 45.6% female) were included in the modelling. The best-fitting GBTM model identified two groups with linear, minimally changing trajectories (76.2% and 19.4% of participants; baseline TUG times 8 ± 2 and 12 ± 3 s, respectively), and a third (4.5%; baseline TUG 17 ± 5 s) with a TUG that increased over time then fell at Year 6, reflecting participant attrition. Both slower groups were older, more likely to be female, obese, and had greater diabetes-associated complications and comorbidities. Almost one-quarter of the FDS2 cohort had clinically relevant mobility impairment that persisted or worsened over six years, was multifactorial in origin, and was associated with excess late withdrawals and deaths. The TUG may have important clinical utility in assessing mobility and its consequences in adults with type 2 diabetes.
Collapse
Affiliation(s)
- David G Bruce
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
| |
Collapse
|
|
10
|
Pinhal KC, Figueiredo PS, De Oliveira VC, Gomes WF, Pernambuco AP, Alcantara MA. Functional decline in people with diabetes: Bidirectional relationships between body function and activity-participation components in a two-wave longitudinal structural equation modeling. Physiother Theory Pract 2023; 39:598-606. [PMID: 35057703 DOI: 10.1080/09593985.2021.2023923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the impact of diabetes over time. The sample included 68 people with diabetes used a three-year longitudinal design to test a model of functional decline. Indicators of the body function and activity and participation components of the International Classification of Functioning, Disability and Health (ICF) were derived from the Nordic Musculoskeletal Questionnaire, World Health Organization Quality of Life-Brief version (WHOQOL-BREF), and Participation Scale. On the basis of the ICF framework, it is hypothesized and found that there is an interaction between the body function and the activity and participation components, which, in turn, are predictors of future functional capability. The structural equation analyses confirmed that at both T1 and T2 pain measures are associated with physical, psychological, and social functioning; environmental factors mediate the relationship between these two constructs. Moreover, the activity and participation component at T1 predicted the body function component at T2. The main finding suggests that functional consequences of diabetes are complex and multifactorial. The significant functional decline in people with diabetes in just three years is worrying. The theoretical and practical implications of these findings are discussed.
Collapse
Affiliation(s)
- Kaio C Pinhal
- Programa de Pós-Graduação Em Reabilitação E Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil
| | - Pedro S Figueiredo
- Programa de Pós-Graduação Em Reabilitação E Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil.,Department of Physiotherapy, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil
| | - Vinícius C De Oliveira
- Programa de Pós-Graduação Em Reabilitação E Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil.,Department of Physiotherapy, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil
| | - Wellington F Gomes
- Department of Physiotherapy, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil
| | - Andrei P Pernambuco
- Department of Physiotherapy, Centro Universitário de Formiga (Unifor-mg), Formiga, Minas Gerais, Brazil
| | - Marcus A Alcantara
- Programa de Pós-Graduação Em Reabilitação E Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil.,Department of Physiotherapy, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (Ufvjm), Brazil
| |
Collapse
|
|
11
|
Martin CL, Trapani VR, Backlund JYC, Lee P, Braffett BH, Bebu I, Lachin JM, Jacobson AM, Gubitosi-Klug R, Herman WH, the DCCT/EDIC Research Group. Physical Function in Middle-aged and Older Adults With Type 1 Diabetes: Long-term Follow-up of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2022; 45:2037-2045. [PMID: 35880807 PMCID: PMC9472495 DOI: 10.2337/dc21-2119] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the prevalence and clinical correlates of functional limitations in middle-aged and older adults with long-standing type 1 diabetes. RESEARCH DESIGN AND METHODS Functional limitations were assessed for 1,094 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, a multicenter, longitudinal, observational follow-up of participants with type 1 diabetes randomly assigned to intensive or conventional diabetes therapy during the Diabetes Control and Complications Trial (DCCT). The primary outcome measure was a score <10 on the Short Physical Performance Battery (SPPB). The secondary outcome, self-reported functional limitation, was assessed by written questionnaire. Logistic regression models were used to assess associations of both outcomes with demographic and clinical factors (glycemic and nonglycemic factors, micro- and macrovascular complications, DCCT cohort, and treatment assignment). RESULTS Participants were 53% male, with mean ± SD age 59.5 ± 6.8 years and diabetes duration 37.9 ± 4.9 years. The prevalence of SPPB score <10 was 21%. The prevalence of self-reported functional limitations was 48%. While DCCT treatment assignment was not associated with physical function outcomes measured ∼25 years after the end of the DCCT, the time-weighted mean DCCT/EDIC HbA1c was associated with both outcomes. Other clinical factors associated with both outcomes in multivariable analyses were BMI, general psychological distress, and cardiac autonomic neuropathy. CONCLUSIONS Almost half of the middle-aged and older adults with long-standing type 1 diabetes reported functional limitations, which were associated with higher HbA1c and BMI, general psychological distress, and cardiac autonomic neuropathy. Future research is needed to determine whether these findings are generalizable.
Collapse
Affiliation(s)
| | | | | | - Pearl Lee
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Ionut Bebu
- Biostatistics Center, The George Washington University, Rockville, MD
| | - John M. Lachin
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Alan M. Jacobson
- NYU Long Island School of Medicine, NYU Langone Hospital–Long Island, Mineola
| | - Rose Gubitosi-Klug
- Case Western Reserve University, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - William H. Herman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
|
12
|
Wu TH, Tsai SC, Lin HW, Chen CN, Hwu CM. Increased serum levels of advanced glycation end products are negatively associated with relative muscle strength in patients with type 2 diabetes mellitus. BMC Endocr Disord 2022; 22:118. [PMID: 35505327 PMCID: PMC9066950 DOI: 10.1186/s12902-022-01035-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In this study, we investigated whether serum levels of advanced glycation end products (AGEs) independently correlated with relative muscle strength after adjustment for clinical variables including diabetic peripheral neuropathy in patients with type 2 diabetes. Relative muscle strength was defined as muscle strength (in decinewtons, dN) divided by total muscle mass (in kg). METHODS We enrolled 152 ambulatory patients with type 2 diabetes. Each participant underwent measurements of muscle strength and total muscle mass. Serum levels of AGEs were determined. The Michigan Neuropathy Screening Instrument Physical Examination (MNSI-PE) was performed to assess diabetic peripheral neuropathy. RESULTS The participants were divided into three groups on the basis of tertiles of serum AGEs levels. Significant differences were observed among the three groups in relative handgrip strength (71.03 ± 18.22, 63.17 ± 13.82, and 61.47 ± 13.95 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.005). The relative muscle strength of the ankle plantar flexors was higher in the low-tertile group than in the mid-tertile and high-tertile groups (107.60 ± 26.53, 94.97 ± 19.72, and 94.18 ± 16.09 dN/kg in the low-tertile, mid-tertile, and high-tertile groups, respectively, P = 0.002). After adjustment for MNSI-PE score and other clinical variables in partial correlation analysis, the correlations between serum levels of AGEs and the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor remained significant. Serum AGEs level was the only variable that remained significantly related to the relative muscle strength of handgrip, ankle dorsiflexor, and ankle plantar flexor when AGEs level, fasting plasma glucose, and glycated hemoglobin (HbA1c) were entered into multiple regression models simultaneously. CONCLUSIONS After adjustment for multiple factors including diabetic peripheral neuropathy, this study demonstrated that increased serum levels of AGEs were independently associated with decreased relative muscle strength in patients with type 2 diabetes. Compared with fasting plasma glucose and HbA1c, serum level of AGEs is more strongly associated with relative muscle strength.
Collapse
Affiliation(s)
- Tsung-Hui Wu
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201 Shi-Pai Rd. Sec. 2, Chung-Cheng Build. 11F Room 522, Taipei, 112, Taiwan
| | - Shiow-Chwen Tsai
- Institute of Sports Science, University of Taipei, Taipei, Taiwan
| | - Hsuan-Wei Lin
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chii-Min Hwu
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201 Shi-Pai Rd. Sec. 2, Chung-Cheng Build. 11F Room 522, Taipei, 112, Taiwan.
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
| |
Collapse
|
|
13
|
Li TJ, Zhou J, Ma JJ, Luo HY, Ye XM. What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research. World J Clin Cases 2022; 10:1226-1241. [PMID: 35211556 PMCID: PMC8855189 DOI: 10.12998/wjcc.v10.i4.1226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/21/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of elderly individuals with diabetes is dramatically increasing. Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management. Understanding of self-management from the patients’ perspectives is important to nurses, healthcare providers, and researchers and benefits people by improving their self-management skills.
AIM To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.
METHODS Electronic databases were searched, including MEDLINE, CINAH, PsycINFO, PubMed, CNKI, and WANFADATA. Relevant research was identified by manually searching reference lists and gray literature. Only English and Chinese publications were included. The Critical Appraisal Skills Program was used to assess the quality of the research. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.
RESULTS A total of 10 qualitative studies were included, and content analysis was performed. Five themes were identified: The need for knowledge about diabetes care, support systems, functional decline, attitudes toward diabetes, and healthy lifestyle challenges.
CONCLUSION This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.
Collapse
Affiliation(s)
- Ting-Jun Li
- Department of Nursing, The Second People's Hospital of Futian District Shenzhen, Shenzhen 518049, Guangdong Province, China
| | - Jie Zhou
- Department of Nursing, Shenzhen Shekou People’s Hospital, Shenzhen 518067, Guangdong Province, China
| | - Juan-Juan Ma
- Department of Nursing, Shenzhen Shekou People’s Hospital, Shenzhen 518067, Guangdong Province, China
| | - Hui-Yan Luo
- Department of Traditional Chinese Medicine, Shenzhen People's Hospital, Shenzhen 518000, Guangdong Province, China
| | - Xiao-Mei Ye
- Intensive Care Unit, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510220, Guangdong Province, China
| |
Collapse
|
|
14
|
Shao D, Wang SS, Sun JW, Wang HP, Sun Q. Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:847348. [PMID: 35574024 PMCID: PMC9099190 DOI: 10.3389/fendo.2022.847348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations. METHODS This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders. RESULTS A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model. CONCLUSIONS HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.
Collapse
Affiliation(s)
- Di Shao
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuang-Shuang Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ji-Wei Sun
- Center for Reproductive Medicine, School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
| | - Hai-Peng Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Qiang Sun,
| |
Collapse
|
|
15
|
Tsai YH, Chuang LL, Lee YJ, Chiu CJ. How Does Diabetes Accelerate Normal Aging? An Examination of ADL, IADL, and Mobility Disability in Middle-aged and Older Adults With and Without Diabetes. Diabetes Res Clin Pract 2021; 182:109114. [PMID: 34756960 DOI: 10.1016/j.diabres.2021.109114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To build an age norm to quantify and compare the different progression rates of disability in people with and without diabetes. METHODS Data were extracted from 5,131 adults aged 50 and older from the Taiwan Longitudinal Study in Aging (TLSA) conducted in 1996. Using multilevel mixed models, the disabilities were measured in 1999, 2003, and 2007. RESULTS Diabetes accelerated the occurrence and progression of disabilities during aging. Participants with diabetes developed to mobility, IADL, and ADL at the age of 55, near the age of 60, and near the age of 70, respectively. Diabetes accelerated the onset of disabilities of mobility by 3 years, IADL by 7 years, and ADL by 11 years. In the fully adjusted model, diabetes remains a robust predictor for levels of disability (MobilityβDM = 1.668, p < 0.001, IADLβDM = 1.031, p < 0.001) (IADβDM = 0.690, p < 0.001), and rate of change for developing mobility disability (MobilityβDM*age = 0.088, p < 0.001). CONCLUSIONS This study showed that diabetes accelerated the occurrence and progression of disabilities starting in middle age. A three to eleven years of acceleration on disability development on mobility, IADL, and ADL was observed.
Collapse
Affiliation(s)
- Yi-Hsuan Tsai
- Division of Plumonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Li-Lun Chuang
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan.
| | - Yau-Jiunn Lee
- Department of Endocrinology & Metabolism, Lee's Endocrinology Clinic, Pingtung, Taiwan.
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
|
16
|
Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol 2021; 17:534-548. [PMID: 34172940 DOI: 10.1038/s41574-021-00512-2] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 02/06/2023]
Abstract
The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.
Collapse
Affiliation(s)
- Srikanth Bellary
- School of Life and Health Sciences, Aston University, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK.
| | - Ioannis Kyrou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, UK
| | - James E Brown
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
| | - Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
| |
Collapse
|
|
17
|
Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Sherman LD. Diabetes Self-Management Among Individuals With Diabetes and Physical Disabilities. Sci Diabetes Self Manag Care 2021; 47:264-278. [PMID: 34384309 DOI: 10.1177/26350106211024136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine diabetes self-management behavior among individuals who have diabetes living with and without physical limitations. METHODS Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey was used. Dependent variables were utilization of dilated eye exams, foot checks, at least 1 dental checkup annually, treating diabetes with oral medication, treating diabetes with insulin injections, and engagement in moderate or vigorous physical exercise 5 times per week. The independent variable was diabetes with physical limitations compared with diabetes without physical limitations. The study controlled for predisposing, enabling, and need factors. RESULTS Findings indicate that individuals with diabetes and physical limitations were less likely to engage in moderate or vigorous physical exercise 5 times per week, have at least 1 annual dental checkup, and treat their diabetes orally with medication. CONCLUSIONS Self-management behavior was poor among individuals with diabetes and physical limitations. Environmental barriers may partially contribute to reasons why individuals with diabetes and physical limitations do not engage in diabetes self-management behaviors that would assist them in mitigating diabetes complications. Other reasons could be the lack of equipment accessibility or adaptability and cultural competence among providers treating/caring for individuals with physical limitations.
Collapse
Affiliation(s)
| | - Shamly Austin
- Research Development & Analytics, Gateway Health, Pittsburgh, Pennsylvania
| | | | - Ledric D Sherman
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas
| |
Collapse
|
|
18
|
Shang Y, Fratiglioni L, Vetrano DL, Dove A, Welmer AK, Xu W. Not Only Diabetes but Also Prediabetes Leads to Functional Decline and Disability in Older Adults. Diabetes Care 2021; 44:690-698. [PMID: 33446522 PMCID: PMC7896268 DOI: 10.2337/dc20-2232] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is linked to functional decline, but the impact of prediabetes on physical function is unknown. We aimed to examine and compare the impact of prediabetes and diabetes on physical function and disability progression and to explore whether cardiovascular diseases (CVDs) mediate these associations. RESEARCH DESIGN AND METHODS A cohort of 2,013 participants aged ≥60 from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing population-based longitudinal study, was monitored for up to 12 years. Physical function was measured with chair stand (s) and walking speed (m/s) tests, and disability was measured by summing the numbers of impaired basic and instrumental activities of daily living. Diabetes was identified through medical examinations or clinical records, medication use, or glycated hemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7-6.4% in participants free of diabetes. CVDs were ascertained through clinical examinations and the National Patient Register. Data were analyzed using mixed-effect models and mediation models. RESULTS At baseline, 650 (32.3%) had prediabetes and 151 had diabetes (7.5%). In multiadjusted mixed-effect models, prediabetes was associated with an increased chair stand time (β 0.33, 95% CI 0.05-0.61), a decreased walking speed (β -0.006, 95% CI -0.010 to -0.002), and an accelerated disability progression (β 0.05, 95% CI 0.01-0.08), even after controlling for the future development of diabetes. Diabetes led to faster functional decline than prediabetes. In mediation analyses, CVDs mediated 7.1%, 7.8%, and 20.9% of the associations between prediabetes and chair stand, walking speed, and disability progression, respectively. CONCLUSIONS Prediabetes, in addition to diabetes, is associated with faster functional decline and disability, independent of the future development of diabetes. This association may be in part mediated by CVDs.
Collapse
Affiliation(s)
- Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome, Italy
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden .,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| |
Collapse
|
|
19
|
Ocagli H, Lanera C, Lorenzoni G, Prosepe I, Azzolina D, Bortolotto S, Stivanello L, Degan M, Gregori D. Profiling Patients by Intensity of Nursing Care: An Operative Approach Using Machine Learning. J Pers Med 2020; 10:jpm10040279. [PMID: 33327412 PMCID: PMC7768500 DOI: 10.3390/jpm10040279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Physical function is a patient-oriented indicator and can be considered a proxy for the assignment of healthcare personnel. The study aims to create an algorithm that classifies patients into homogeneous groups according to physical function. A two-step machine-learning algorithm was applied to administrative data recorded between 2015 and 2018 at the University Hospital of Padova. A clustering-large-applications (CLARA) algorithm was used to partition patients into homogeneous groups. Then, machine learning technique (MLT) classifiers were used to categorize the doubtful records. Based on the results of the CLARA algorithm, records were divided into three groups according to the Barthel index: <45, >65, ≥45 and ≤65. The support vector machine was the MLT showing the best performance among doubtful records, reaching an accuracy of 66%. The two-step algorithm, since it splits patients into low and high resource consumption, could be a useful tool for organizing healthcare personnel allocation according to the patients' assistance needs.
Collapse
Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
| | - Ilaria Prosepe
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Sabrina Bortolotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
| | - Lucia Stivanello
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (L.S.); (M.D.)
| | - Mario Degan
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (L.S.); (M.D.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan, 18, 35121 Padova, Italy; (H.O.); (C.L.); (G.L.); (I.P.); (D.A.); (S.B.)
- Correspondence: ; Tel.: +39-049-8275384
| |
Collapse
|
|
20
|
Ocagli H, Cella N, Stivanello L, Degan M, Canova C. The Barthel index as an indicator of hospital outcomes: A retrospective cross-sectional study with healthcare data from older people. J Adv Nurs 2020; 77:1751-1761. [PMID: 33277770 DOI: 10.1111/jan.14708] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/28/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost. DESIGN This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016. METHODS A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index. RESULTS A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI 9.22-18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96-5.45), and a 2-fold increase in length of stay (OR = 2.56; 95% CI 2.34-2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index. CONCLUSIONS Barthel Index was strongly associated with in-hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients' functional impairment. IMPACT The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.
Collapse
Affiliation(s)
- Honoria Ocagli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Nicoletta Cella
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,Department of Internal Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Lucia Stivanello
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Mario Degan
- Health professional Management Service (DPS) of the University Hospital of Padova, Padova, Italy
| | - Cristina Canova
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
|
21
|
Chao YY, Zha P, Yang K, Dong X. Association between physical function and perceived stress among U.S. Chinese older adults. AMERICAN JOURNAL OF AGING SCIENCE AND RESEARCH 2020; 1:12-19. [PMID: 33135012 PMCID: PMC7595296 DOI: 10.46439/aging.1.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Physical function impairment can cause great stress to older adults.
The purpose of the study is to investigate the association between
self-reported and directly-observed physical function on perceived stress
among U.S. Chinese older adults. Methods Data were from the Population Study of Chinese Elderly in Chicago
(PINE) of 3,157 Chinese older adults who were 60 and above in the Greater
Chicago Area. Self-reported and directly-observed physical function
measures, and Perceived Stress Scale were used. Results Participants had a mean age of 72.8 ± 8.3 years old (range
60–105). Higher scores of Katz activities of daily living impairments
(odds ratio [OR]=1.77), Lawton instrumental activities of daily living
impartments (OR=1.10, p<0.01), Rosow–Breslau
index of mobility scale (OR=1.39, p<0.05), and Nagi
index of basic physical activities scale (OR=1.19,
p<0.001) were associated with higher levels of
perceived stress. In addition, higher scores of directly-observed physical
function measurements, including chair stand (OR=0.93), tandem stand
(OR=0.71, p<0.05), timed walk (OR=0.73,
p<0.001), and the overall measurement (OR= 0.87,
p<0.01) were associated with lower level of
perceived stress. Discussion Findings suggested that poor physical function was associated with
perceived stress among U.S. Chinese older adults. Longitudinal studies are
needed to obtain a more comprehensive understanding of the pathways between
physical function and perceived stress. Implications for practice Health care professionals could provide personalized physical
activity interventions to encourage older adults to engage in regular
exercise in order to maintain and promote older adults’ physical
function and psychological well-being.
Collapse
Affiliation(s)
- Ying-Yu Chao
- Clinical Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Peijia Zha
- Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Kyeongra Yang
- Associate Professor, Rutgers, the State University of New Jersey, School of Nursing, 65 Bergen Street, Room 1025E, Newark, NJ 07107, USA
| | - XinQi Dong
- Director, Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St, New Brunswick, NJ, 08901, USA
| |
Collapse
|
|
22
|
Christiansen CL, Miller MJ, Kline PW, Fields TT, Sullivan WJ, Blatchford PJ, Stevens-Lapsley JE. Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial. PM R 2020; 12:957-966. [PMID: 32248638 PMCID: PMC8229675 DOI: 10.1002/pmrj.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. OBJECTIVE To test the feasibility of a biobehavioral intervention designed to promote physical activity. DESIGN A randomized, single-blind feasibility trial with a crossover design. SETTING Veterans Administration Medical Center. PARTICIPANTS Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). INTERVENTIONS Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. MAIN OUTCOME MEASURES Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index - Disability Scale [LLFDI-DS]). RESULTS Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = -0.15) or LLFDI-DS (d = -0.22 and 0.17 for frequency and limitations scales, respectively). CONCLUSIONS Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.
Collapse
Affiliation(s)
- Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Paul W Kline
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Thomas T Fields
- Department of Physical Medicine and Rehabilitation, Rocky Mountain Regional Medical Center, Aurora, CO
| | - William J Sullivan
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick J Blatchford
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| |
Collapse
|
|
23
|
Acute application of photobiomodulation does not bring important gains for the muscular performance and functionality of diabetic individuals. Lasers Med Sci 2020; 36:995-1002. [PMID: 32862403 DOI: 10.1007/s10103-020-03135-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Photobiomodulation therapy (PBMT) has been used to improve the physical performance of individuals with advanced age; however, there are no studies in the literature that support the application of light-emitting diode (LED) therapy for the muscular performance of individuals with diabetes mellitus who show a decline in functionality. The aim of the study was to analyze the acute effects of PBMT on strength and functional performance in type 2 diabetic individuals. Sixty-three volunteers were recruited and randomized into five groups: control (C), sham (S), red LED (R), infrared LED (IR), and red LED + infrared LED (R + IR). On the first day, the volunteers were evaluated using the time up and go (TUG), the 6-min walk test (6MWT), and isokinetic dynamometer of the ankle. In the following 3 days, groups R, IR, R + IR, and S returned for application of PBMT bilaterally, with 180 J of energy on each leg. On the fifth day, a reassessment was performed. There was no statistical difference between groups for the variables of the isokinetic dynamometer, TUG, and 6MWT. Analysis of the size of the clinical effect for the isokinetic variables showed that there was no pattern among the effects observed. There is a moderate effect in favor of R, IR, and R + IR in relation to C for the TUG and a moderate effect of R + IR in relation to C for the 6MWT. The PBMT applied for a short period does not bring important gains for the muscular performance and functionality of diabetic individuals.
Collapse
|
|
24
|
Elran-Barak R, Weinstein G, Beeri MS, Ravona-Springer R. The associations between objective and subjective health among older adults with type 2 diabetes: The moderating role of personality. J Psychosom Res 2019; 117:41-47. [PMID: 30665595 DOI: 10.1016/j.jpsychores.2018.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Objective and subjective health are two powerful constructs which predict morbidity and mortality across a range of conditions including Type 2 Diabetes (T2D). Studies, however, suggest that these two constructs do not necessarily correlate, as some people with poor objective health perceive their health as good, while other people with good objective health perceive their health as poor. We seek to examine the role of personality as a moderator of the associations between objective and subjective health among older adults with T2D, who are likely to experience poor objective and subjective health due to their chronic medical condition. METHODS Cross-sectional study of 368 individuals with T2D (72 ± 4 years, 42% women), participating in the Israel Diabetes and Cognitive Decline Study. Personality was conceptualized using the five-factor model (agreeableness, conscientiousness, extraversion, neuroticism, openness). Objective health was operationalized by T2D-related clinical status, cognitive function, and motor ability. Subjective health was assessed using a single self-report question. Hayes' process macro was used for the moderation analyses. RESULTS The objective-subjective health associations were stronger among individuals with increased neuroticism (proportion of days covered: p = 0.02; cognitive function: p = 0.003; hand grip: p = 0.02; 3-m walk: p = 0.04) as well as decreased openness (cognitive status: p = 0.04) and agreeableness (3-m walk: p = 0.02). DISCUSSION Personality traits, and specifically neuroticism, can modify the associations between objective and subjective health in older adults with T2D. Findings contribute to the understanding of health as a multidimensional construct that encompasses medical and psychological aspects, especially among older adults with a chronic illness.
Collapse
Affiliation(s)
| | | | - Michal Schnaider Beeri
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Memory Clinic, Division of Psychiatry, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
|
25
|
Chen HM, Hsiao SM, Kuo MC, Lo YC, Huang MF, Yeh YC, Yen CF, Chen CS. Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures. PeerJ 2018; 6:e5286. [PMID: 30042897 PMCID: PMC6054786 DOI: 10.7717/peerj.5286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD). Methods A cross-sectional study of 99 patients with stage 4-5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton-Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed. Results Only IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL. Conclusion Performance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.
Collapse
Affiliation(s)
- Hui-Mei Chen
- Department of Occupational Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ming Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lo
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
|
26
|
Machado-Fragua MD, Struijk EA, Graciani A, Guallar-Castillon P, Rodríguez-Artalejo F, Lopez-Garcia E. Coffee consumption and risk of physical function impairment, frailty and disability in older adults. Eur J Nutr 2018; 58:1415-1427. [PMID: 29549497 DOI: 10.1007/s00394-018-1664-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Habitual coffee consumption has been associated with lower risk of type 2 diabetes and cardiovascular disease. Since these diseases are main determinants of functional limitations, we have tested the hypothesis that coffee intake is associated with lower risk of physical function impairment, frailty and disability in older adults. We focused on women and those with obesity, hypertension or type 2 diabetes because they are at higher risk of functional limitations. METHODS Prospective study with 3289 individuals ≥ 60 years from the Seniors-ENRICA cohort. In 2008-2010 coffee consumption was measured through a validated dietary history. Participants were followed up until 2015 to ascertain incident impaired physical function, frailty and disability, assessed by both self-report and objective measures. RESULTS Compared with non-drinking coffee, consumption of ≥ 2 cups of coffee/day was associated with lower risk of impaired agility in women (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.51-0.97, P trend 0.04) and in those with obesity (HR 0.60; 95% CI 0.40-0.90, P trend 0.04). Intake of ≥ 2 cups of coffee/day was also linked to reduced risk of impaired mobility in women (HR 0.66; 95% CI 0.46-0.95, P trend 0.02) and among individuals with hypertension (HR 0.70, 95% CI 0.48-1.00, P trend 0.05). Moreover, among subjects with diabetes, those who consumed ≥ 2 cups/day had lower risk of disability in activities of daily living (HR 0.30, 95% CI 0.11-0.76, P trend 0.01). CONCLUSIONS In older people, habitual coffee consumption was not associated with increased risk of functional impairment, and it might even be beneficial in women and those with hypertension, obesity or diabetes.
Collapse
Affiliation(s)
- Marcos D Machado-Fragua
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain. .,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain. .,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Pilar Guallar-Castillon
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, s/n, 28029, Madrid, Spain. .,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain. .,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain. .,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain.
| |
Collapse
|
|
27
|
Costa Filho AM, Mambrini JVDM, Malta DC, Lima-Costa MF, Peixoto SV. Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013). CAD SAUDE PUBLICA 2018; 34:e00204016. [DOI: 10.1590/0102-311x00204016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/25/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract: This study’s objective was to assess the contribution of selected chronic diseases to the prevalence of disability in elderly Brazilians, based on data from the National Health Survey (PNS 2013). Disability was defined as some degree of difficulty in performing ten activities, considering three levels: (i) without disability; (ii) disabled only in some instrumental activity of daily living (IADL); and (iii) disabled in some basic activity of daily living (BADL). The multinomial additive hazards model was the attribution method used to assess the contribution of each self-reported chronic condition (hypertension, diabetes, arthritis, stroke, depression, heart disease, and lung disease) to the prevalence of disability in this population, stratified by sex and age bracket (60 to 74 years and 75 or older). Study participants included 10,537 elderly Brazilians with a mean age of 70.0 years (SD = 7.9 years) and predominance of women (57.4%). Prevalence rates for disability in at least one IADL and at least one BADL were 14% (95%CI: 12.9; 15.1) and 14.9% (95%CI: 13.8; 16.1), respectively. In general, the contribution of chronic diseases to prevalence of disability was greater in younger elderly (60 to 74 years) and in the group with greatest severity (disabled in BADL), highlighting the relevance of stroke and arthritis in men, and arthritis, hypertension, and diabetes in women. This knowledge can help orient health services to target specific groups, considering age, sex, and current illnesses, aimed at preventing disability in the elderly.
Collapse
|
|
28
|
King LK, Kendzerska T, Waugh EJ, Hawker GA. Impact of Osteoarthritis on Difficulty Walking: A Population-Based Study. Arthritis Care Res (Hoboken) 2017; 70:71-79. [PMID: 28513082 DOI: 10.1002/acr.23250] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/28/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the relationship of hip and knee osteoarthritis (OA) to walking difficulty. METHODS A population cohort ages ≤55 years recruited from 1996 to 1998 (n = 28,451) completed a standardized questionnaire assessing demographics, health conditions, joint symptoms, and functional limitations, including difficulty walking in the past 3 months. Survey data were linked to health administrative databases; self-report and administrative data were used to identify health conditions. Hip/knee OA was defined as self-reported swelling, pain, or stiffness in a hip or knee lasting ≥6 weeks in the past 3 months without an inflammatory arthritis diagnosis. Using multivariable logistic regression, we examined the determinants of walking difficulty and constructed a clinical nomogram. RESULTS A total of 18,490 cohort participants were eligible (mean age 68 years, 60% women), and 25% reported difficulty walking. Difficulty walking was significantly and independently associated with older age, female sex, body mass index, and several health conditions. Of the conditions examined, the likelihood of walking difficulty was greatest with hip and knee OA and increased with the number of hip/knee joints affected. The predicted probability of difficulty walking for a 60-year-old middle-income, normal-weight woman was 5-10% with no health conditions, 10-20% with diabetes mellitus and cardiovascular (CV) disease, 40% with OA in 2 hips/knees, 60-70% with diabetes mellitus, CV disease, and OA in 2 hips/knees, and 80% with diabetes mellitus, CV disease, and OA in all hips/knees. CONCLUSION In a population cohort, symptomatic hip/knee OA was the strongest contributor to walking difficulty. Given the importance of walking to engagement in physical activity for chronic disease management, greater attention to OA is warranted.
Collapse
Affiliation(s)
| | - Tetyana Kendzerska
- University of Toronto, Women's College Research Institute, Women's College Hospital, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Esther J Waugh
- Women's College Research Institute, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Gillian A Hawker
- University of Toronto, Women's College Research Institute, Women's College Hospital, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| |
Collapse
|
|
29
|
Hu X, Xiao RP. MG53 and disordered metabolism in striated muscle. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1984-1990. [PMID: 29017896 DOI: 10.1016/j.bbadis.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/25/2022]
Abstract
MG53 is a member of tripartite motif family (TRIM) that expressed most abundantly in striated muscle. Using rodent models, many studies have demonstrated the MG53 not only facilitates membrane repair after ischemia reperfusion injury, but also contributes to the protective effects of both pre- and post-conditioning. Recently, however, it has been shown that MG53 participates in the regulation of many metabolic processes, especially insulin signaling pathway. Thus, sustained overexpression of MG53 may contribute to the development of various metabolic disorders in striated muscle. In this review, using cardiac muscle as an example, we will discuss muscle metabolic disturbances associated with diabetes and the current understanding of the underlying molecular mechanisms; in particular, the pathogenesis of diabetic cardiomyopathy. We will focus on the pathways that MG53 regulates and how the dysregulation of MG53 leads to metabolic disorders, thereby establishing a causal relationship between sustained upregulation of MG53 and the development of muscle insulin resistance and metabolic disorders. This article is part of a Special issue entitled Cardiac adaptations to obesity, diabetes and insulin resistance, edited by Professors Jan F.C. Glatz, Jason R.B. Dyck and Christine Des Rosiers.
Collapse
Affiliation(s)
- Xinli Hu
- State Key Laboratory of Membrane Biology, Institute of Molecular Medicine, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, China; Beijing City Key Laboratory of Cardiometabolic Molecular Medicine, Peking University, Beijing 100871, China
| | - Rui-Ping Xiao
- State Key Laboratory of Membrane Biology, Institute of Molecular Medicine, Peking University, Beijing 100871, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, China; Beijing City Key Laboratory of Cardiometabolic Molecular Medicine, Peking University, Beijing 100871, China.
| |
Collapse
|
|
30
|
Fritschi C, Bronas UG, Park CG, Collins EG, Quinn L. Early declines in physical function among aging adults with type 2 diabetes. J Diabetes Complications 2017; 31:347-352. [PMID: 27450624 PMCID: PMC5191982 DOI: 10.1016/j.jdiacomp.2016.06.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/03/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022]
Abstract
AIMS Type 2 diabetes (T2DM) is associated with reduced physical function and early disability. We hypothesized that changes in physical function occur early and differ by age. Our aims were to determine and compare differences in and predictors of physical function in older and younger adults with T2DM. METHODS Eighty adults completed six-minute walk distance (6MWD) tests, wore wrist actigraphy for 5days and completed diabetes health and symptom surveys. Comparative and bivariate analyses were completed to assess differences between age groups determined by serial Box's M-plot analyses. RESULTS 6MWD was low (476.9±106.2m), and negatively associated with female gender, age, neuropathic pain, diabetes duration, BMI, poor sleep quality, and fatigue and positively with habitual activity and education (p<0.05). Covariance matrices changed at age 59. In subjects age <58, 6MWD was predicted by gender, sleep quality, and neuropathic pain (R2=0.593, p<0.001). In those age ≥59, 6MWD was predicted by diabetes duration, education, and habitual activity (R2=0.554, p<0.001). There were no shared predictors of 6MWD between groups. CONCLUSIONS T2DM is associated with early declines in physical function; the predictors of which change in midlife. Therapies to maintain or improve physical function should be tailored by age, pain symptoms, and habitual activity levels.
Collapse
Affiliation(s)
- Cynthia Fritschi
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL.
| | - Ulf Gunnar Bronas
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL
| | - Chang G Park
- University of Illinois at Chicago College of Nursing, Chicago, IL
| | - Eileen G Collins
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL; Research & Development, Edward Hines Jr., VA Hospital, Hines, IL
| | - Laurie Quinn
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL
| |
Collapse
|
|
31
|
Hawker GA, Croxford R, Bierman AS, Harvey P, Ravi B, Kendzerska T, Stanaitis I, King LK, Lipscombe L. Osteoarthritis-related difficulty walking and risk for diabetes complications. Osteoarthritis Cartilage 2017; 25:67-75. [PMID: 27539890 DOI: 10.1016/j.joca.2016.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the effect of Osteoarthritis (OA)-related difficulty walking on risk for diabetes complications in persons with diabetes and OA. DESIGN A population cohort aged 55+ years with symptomatic hip and knee OA was recruited 1996-98 and followed through provincial administrative data to 2015 (n = 2,225). In those with confirmed OA (examination and radiographs) and self-reported diabetes at baseline (n = 359), multivariate Cox regression modeling was used to examine the relationship between baseline difficulty walking (Health Assessment Questionnaire (HAQ) difficulty walking score; use of walking aid) and time to first diabetes-specific complication (hospitalization for hypo- or hyperglycemia, infection, amputation, retinopathy, or initiation of chronic renal dialysis) and cardiovascular (CV) events. RESULTS Participants' mean baseline age was 71.4 years; 66.9% were female, 77.7% had hypertension, 54.0% had pre-existing CV disease, 42.9% were obese and 15.3% were smokers. Median HAQ difficulty walking score was 2/3 indicating moderate to severe walking disability; 54.9% used a walking aid. Over a median 6.1 years, 184 (51.3%) experienced one or more diabetes-specific complications; 191 (53.2%) experienced a CV event over a median 5.7 years. Greater baseline difficulty walking was associated with shorter time to the first diabetes-specific complication (adjusted HR per unit increase in HAQ walking 1.24, 95% CI 1.04-1.47, P = 0.02) and CV event (adjusted HR for those using a walking aid 1.35, 95% CI 1.00-1.83, P = 0.04). CONCLUSIONS In a population cohort with OA and diabetes, OA-related difficulty walking was a significant - and potentially modifiable - risk factor for diabetes complications.
Collapse
Affiliation(s)
- G A Hawker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - R Croxford
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A S Bierman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - P Harvey
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Ravi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - T Kendzerska
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - I Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - L K King
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
32
|
Spauwen PJJ, Martens RJH, Stehouwer CDA, Verhey FRJ, Schram MT, Sep SJS, van der Kallen CJH, Dagnelie PC, Henry RMA, Schaper NC, van Boxtel MPJ. Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study. Diabet Med 2016; 33:1632-1639. [PMID: 26926848 DOI: 10.1111/dme.13105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/19/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022]
Abstract
AIMS To determine the association of verbal intelligence, a core constituent of health literacy, with diabetic complications and walking speed in people with Type 2 diabetes. METHODS This study was performed in 228 people with Type 2 diabetes participating in the Maastricht Study, a population-based cohort study. We examined the cross-sectional associations of score on the vocabulary test of the Groningen Intelligence Test with: 1) determinants of diabetic complications (HbA1c , blood pressure and lipid level); 2) diabetic complications: chronic kidney disease, neuropathic pain, self-reported history of cardiovascular disease and carotid intima-media thickness; and 3) walking speed. Analyses were performed using linear regression and adjusted in separate models for potential confounders and mediators. Significant age- and sex-adjusted associations were additionally adjusted for educational level in a separate model. RESULTS After full adjustment, lower verbal intelligence was associated with the presence of neuropathic pain [odds ratio (OR) 1.18, 95% CI 1.02;1.36], cardiovascular disease (OR 1.14, 95% CI 1.01;1.30), and slower walking speed (regression coefficient -0.011 m/s, 95% CI -0.021; -0.002 m/s). These associations were largely explained by education. Verbal intelligence was not associated with blood pressure, glycaemic control, lipid control, chronic kidney disease or carotid intima-media thickness. CONCLUSIONS Lower verbal intelligence was associated with the presence of some diabetic complications and with a slower walking speed, a measure of physical functioning. Educational level largely explained these associations. This implies that clinicians should be aware of the educational level of people with diabetes and should provide information at a level of complexity tailored to the patient.
Collapse
Affiliation(s)
- P J J Spauwen
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R J H Martens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - F R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - S J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - C J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - P C Dagnelie
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - R M A Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - N C Schaper
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - M P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
|
33
|
Yalamanchi SV, Stewart KJ, Ji N, Golden SH, Dobs A, Becker DM, Vaidya D, Kral BG, Kalyani RR. The relationship of fasting hyperglycemia to changes in fat and muscle mass after exercise training in type 2 diabetes. Diabetes Res Clin Pract 2016; 122:154-161. [PMID: 27855341 PMCID: PMC5683408 DOI: 10.1016/j.diabres.2016.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 08/03/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022]
Abstract
AIMS Exercise training (ET) has been variably associated with body composition changes among persons with type 2 diabetes (T2DM). The degree to which these changes are related to hyperglycemia remains unclear. Our objective was to investigate the relationship of baseline fasting glucose (FG) to the magnitude of muscle gains and fat loss after ET in individuals with T2DM. METHODS Participants were enrolled in the SHAPE-2 trial, a six month supervised aerobic and resistance training intervention (three days/week), at Johns Hopkins. This was a post hoc single arm intervention study of participants who completed the exercise intervention (n=50). Participants were aged 40-65years and had T2DM that was not treated with insulin. Body composition was assessed by DEXA. RESULTS After 6months of ET, total fat mass decreased (-2.1±3.1kg) and total lean body mass (LBM) increased (0.5±2.0kg) overall, but there was variability among individual participants. There was an increase in % total LBM (1.4±1.9%) and decrease in % total body fat mass (-1.5±2.0%) after ET. Interestingly, each standard deviation (SD) increase in baseline FG (mean=135.5mg/dl; SD=39.0mg/dl) was related to a significant increase in % total LBM (0.54±0.26%, p=0.048) and decrease in % total body fat (-0.57±0.27%, p=0.04) after ET among individual participants. CONCLUSIONS Our data demonstrate that muscle gains and fat loss after ET are positively related to baseline hyperglycemia. Further studies are needed to characterize differences in metabolic response following ET among persons with diabetes.
Collapse
Affiliation(s)
- Swaytha V Yalamanchi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Kerry J Stewart
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Nan Ji
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Sherita H Golden
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Adrian Dobs
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Diane M Becker
- Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Brian G Kral
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| |
Collapse
|
|
34
|
Bianchi L, Volpato S. Muscle dysfunction in type 2 diabetes: a major threat to patient's mobility and independence. Acta Diabetol 2016; 53:879-889. [PMID: 27393005 DOI: 10.1007/s00592-016-0880-y] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/22/2016] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes, a common metabolic disease in older people, is a major risk factor for functional limitation, impaired mobility, and loss of independence. In older people, the pathogenesis of functional limitation and disability is complex and multifactorial. A number of potential pathways are involved including cardiovascular disease, peripheral neuropathy, overweight, osteoarthritis, visual deficit, and cognitive impairment, conditions that are all more prevalent among patients with diabetes. Sarcopenia, a geriatric condition characterized by a progressive and generalized loss of skeletal muscle mass and strength, is also involved in the pathogenesis of functional limitations and disability. Recent research has shown that older patients with type 2 diabetes are often affected by skeletal muscle impairment, leading to reduced muscle strength and physical function. Insulin resistance, hyperglycemia, muscle fat infiltration, and peripheral neuropathies are hypothesized as the fundamental biological mechanisms leading to muscle impairment in people with diabetes. This review summarizes the current literature on the biological pathways responsible for skeletal muscle dysfunction in type 2 diabetes and analyzes the role of decline in muscle strength and quality on the association between diabetes and mobility disability.
Collapse
Affiliation(s)
- Lara Bianchi
- Department of Medical Science, University of Ferrara, Via Savonarola, 9, 44100, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Via Savonarola, 9, 44100, Ferrara, Italy.
| |
Collapse
|
|
35
|
Marinho FS, Moram CBM, Rodrigues PC, Franzoi ACOB, Salles GF, Cardoso CRL. Profile of disabilities and their associated factors in patients with type 2 diabetes evaluated by the Canadian occupational performance measure: the Rio De Janeiro type 2 diabetes cohort study. Disabil Rehabil 2016; 38:2095-2101. [PMID: 26729414 DOI: 10.3109/09638288.2015.1111440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the profile of disability in patients with type 2 diabetes and to evaluate its associated variables. METHOD The Canadian Occupational Performance Measure (COPM) assessed disabilities in 475 type 2 diabetic individuals. The activities were categorised by the International Classification of Functioning, Disability and Health. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was used to evaluate pain, emotional and physical functioning domains of life-quality. Multivariable logistic regression assessed the independent correlates of better/worse performance. RESULTS Median COPM score was 4.5 (interquartile range 3-6). Problems in mobility (53.6%), self-care (21.1%) and daily-life (13.0%) were most frequently self-reported. Presence of restriction/pain in the upper limbs (odds ratio [OR]: 1.66; 95% CI: 1.11-2.47; p=0.013) and of peripheral neuropathy (OR: 1.64; 95% CI: 1.06-2.53; p=0.026) were associated with greater chance of worse performance. Higher values of SF-36 in pain and emotional domains (each 10 point increase; OR: 0.92 95% CI: 0.85-0.98; p=0.011; OR: 0.96; 95% CI: 0.92-1.00; p=0.063, respectively) and physical activity (OR: 0.63; 95% CI: 0.41-0.98; p=0.042) were associated with better performance. CONCLUSIONS Type 2 diabetic patients frequently reported disabilities in mobility, self-care and daily-life domains; and its associated factors were the presence of depression, upper limb pain and diabetic peripheral neuropathy. Implications for Rehabilitation The Canadian Occupational Performance Measure (COPM) instrument can be applied to patients with diabetes, as it identifies several disabilities, mostly in mobility, self-care and domestic life areas. Rehabilitation directed to upper limb pain/limitation and to lower limb peripheral neuropathy shall be implemented and may improve diabetic patients' performance and quality of life. A patient-centered rehabilitation strategy, guided by the COPM, may enable greater independence and autonomy, but this should be confirmed in future intervention studies.
Collapse
Affiliation(s)
- Fernanda S Marinho
- a Department of Occupational Therapy , Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| | - Camila B M Moram
- a Department of Occupational Therapy , Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| | - Priscila C Rodrigues
- a Department of Occupational Therapy , Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| | - Ana C O B Franzoi
- b Department of Internal Medicine , School of Medicine, Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| | - Gil F Salles
- b Department of Internal Medicine , School of Medicine, Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| | - Claudia R L Cardoso
- b Department of Internal Medicine , School of Medicine, Universidade Federal Do Janeiro , Rio De Janeiro , Brazil
| |
Collapse
|
|
36
|
Arik G, Varan HD, Yavuz BB, Karabulut E, Kara O, Kilic MK, Kizilarslanoglu MC, Sumer F, Kuyumcu ME, Yesil Y, Halil M, Cankurtaran M. Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr 2015; 61:344-50. [DOI: 10.1016/j.archger.2015.08.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/11/2015] [Accepted: 08/20/2015] [Indexed: 11/26/2022]
|