%0 Journal Article %J Lancet Diabetes Endocrinol %D 2016 %T Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Activities of Daily Living %K Aged %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K United States %X

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention.

%B Lancet Diabetes Endocrinol %V 4 %P 686-694 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27298181 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27298181?dopt=Abstract %R 10.1016/S2213-8587(16)30090-0 %0 Journal Article %J Diabetes Care %D 2015 %T Disability-Free Life-Years Lost Among Adults Aged ≥50 Years, With and Without Diabetes %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Health Conditions and Status %K Methodology %X OBJECTIVE Quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability.RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living IADL , and/or difficulty with activities of daily living ADL ) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998.RESULTS From age 50, adults with diabetes died 4.6 years earlier, developed disability 6 7 years earlier, and spent about 1 2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as much of their remaining years disabled (20 24 of remaining life across the three disability definitions) as men without diabetes (12 16 of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women.CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity. %B Diabetes Care %G eng %U http://care.diabetesjournals.org/content/early/2015/12/17/dc15-1095.abstract %4 Diabetes/methodology/Disabilities/Longevity %$ 999999 %R 10.2337/dc15-1095 %0 Journal Article %J Diabetes Care %D 2014 %T Association of functional decline with subsequent diabetes incidence in u.s. Adults aged 51 years and older: the health and retirement study 1998-2010 %A Barbara H. Bardenheier %A Edward W Gregg %A Zhuo, Xiaohui %A Yiling J. Cheng %A Geiss, Linda S. %K Demographics %K Disabilities %K Health Conditions and Status %K Risk Taking %X OBJECTIVE We assessed whether functional decline and physical disability increase the subsequent risk of diabetes. RESEARCH DESIGN AND METHODS We used a subsample of adults aged 51 years and older with no diabetes at baseline who were followed up to 12 years (1998-2010) in the Health and Retirement Study, an observational study of a nationally representative survey. We assessed baseline disability status and incident disability with subsequent risk of diabetes, accounting for death as a competing risk and controlling for BMI, age, sex, race/ethnicity, net wealth, mother's level of education, respondents' level of education, and time of follow-up. Disability was defined as none, mild, moderate, and severe, based on a validated scale of mobility measures. Diabetes was identified by self-report of a diagnosis from a doctor. Population attributable fraction (PAF) was calculated to assess the percentage of diabetes cases that were attributable to mobility disability. RESULTS The sample included 22,878 adults with an average of 8.7 years of follow-up; 9,649 (41.2 ) reported some level of disability at baseline, and 8,175 (35.7 ) additional participants developed disability during follow-up; 3,546 (15.5 ) participants developed diabetes; and 5,869 (25.6 ) died. Regression analyses found a statistically significant dose-response relationship of increased risk of diabetes (28-95 ) among those with any level of functional decline, prevalent or incident. Among the subanalytic sample, including incident disability only, the PAF was 6.9 (CI 4.2-9.5). CONCLUSIONS Our findings suggest those who become disabled, even mildly, are at increased risk of developing diabetes. This finding raises the possibility that approaches to prevent disability in older adults could also reduce diabetes incidence. %B Diabetes Care %I 37 %V 37 %P 1032-8 %G eng %N 4 %4 Diabetes/Disabilities/Disability/Disability/functional decline/functional decline/incident disability/mobility/mobility difficulty/Risk Factor %$ 999999 %R 10.2337/dc13-2216