Assessment of Functional Disability in Osteoarthritis Patients with and without Diabetes Mellitus

Introduction: The objective of this dissertation was to determine if diabetes mellitus (DM) increases the odds of disability in an osteoarthritis (OA) population. A cost-effectiveness analysis (CEA) was performed to determine an optimal treatment strategy.

Methods: This was a cross-sectional, observational design using the Health and Retirement Study (HRS) data. A bivariate analysis was used to assess the differences between OA patients with and without the diagnosis of disability. A Pearson’s chi-square test was used for categorical covariates and the Student’s t-test was used for continuous covariates. Multiple logistic regression was used to determine if a patient with the dyad had higher odds of developing disability after controlling for gender, age, BMI, race/ethnicity, total household income, education, comorbidities, work limits because of health, and self-reported health. A CEA using a Markov model was performed to provide insight into whether surgery is the optimal treatment for patients with end-stage OA and DM when compared to a non-surgical treatment strategy.

Results: The final sample size included 9,700 respondents of which 31.8% (n = 3,083) self-reported DM. There was a significant association between disability and DM (χ2 (df = 1, N = 9700) = 194.05, P < .001). Patients with DM had greater odds of reporting disability (OR 1.118, 95% CI 0.996-1.256, P = .059) though the model did not reach statistical significance. The CEA demonstrated that the undominated strategy for OA treatment was TJA in patients with the dyad.

Discussion: The results of this study support the use of TJA in patients with the dyad as a cost-effective strategy for treatment.