Diabetes mellitus and functional impairment in Taiwanese older men and women

doi:10.1016/S0167-4943(10)70004-2

Archives of Gerontology and Geriatrics

Volume 50, Supplement 1, February 2010, Pages S6-S10

https://doi.org/10.1016/S0167-4943(10)70004-2 Get rights and content

Abstract

Type 2 diabetes mellitus is strongly related to many kinds of functional impairment, even after adjusting for demographic and comorbid conditions. The current study examined sex differences in the relationships between Type 2 diabetes mellitus and functional impairment in an Asian population sample. Data were obtained from a national survey, the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. A total of 652 older adults aged ≥65 years were included in the study. Pearson's χ²-test and multiple logistic regression analysis were used to examine the relationships between diabetes and functional impairments in older men and women. The reported numbers of impairments were significantly higher in women, in those aged ≥75 years, and in those with diabetes. There were sex and age differences in the relationships between diabetes and functional difficulties. Even after adjustment for age, education, and co-morbid conditions, men with diabetes were about four times more likely to have difficulties related to self-care, and women with diabetes were about two to three times more likely to have difficulties related to higher functioning than their non-diabetic counterparts. Sex differences should be considered when understanding the relationships between diabetes and functional impairments in older adults.

Introduction

Several cross-sectional and longitudinal studies have found that type 2 diabetes mellitus (DM) is strongly related to many kinds of functional impairments, including problems with mobility, balance, housework, and self-care, in older adults. These relationships remained significant even after adjusting for demographic factors (e.g., age, sex, education, and ethnicity) and common diabetes-related and diabetes-unrelated comorbidities (e.g., Rekeneire et al., 2003; Wray et al., 2005). Gender differences in functioning have been found in many studies involving older adults (Rahman and Liu, 2000; Liang et al., 2008). Although most of the studies focusing on diabetes and functioning partially accounted for the sex effect, only a few further explored the differences in the relationship between diabetes and functional impairment between older men and women (Gregg et al., 2000). Furthermore, it is unclear whether the results are applicable to older Asian people, because most of these studies took place in Western populations (e.g., Maty et al., 2004; Sinclair et al., 2008); Asian studies have been relatively rare (Chou and Chi, 2005).

In 2006, the prevalence of diabetes in Taiwan was around 14.5% in elderly men and 13.9% in elderly women (Chen et al., 2001); people with diabetes had relatively higher mortality rates (Tseng, 2004), and diabetes was ranked the fourth cause of death (Department of Health, Taiwan, 2006). The current study aimed to assess the sex differences in functional impairment related to diabetes in elderly Taiwanese people, and to examine if these relationships remained significant after adjusting for demographic factors and comorbidities.

Section snippets

Study population

The data used in this study were from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, which was a random subsample of an ongoing survey, the Taiwan Longitudinal Study on Aging (TLSA). The TLSA began in 1989 with a nationally representative sample of persons 60 years and older. The SEBAS survey procedures were approved by the institutional review boards at the Bureau of Health Promotion of the Department of Health, Taiwan, Princeton University, and Georgetown University,

Results

Of the 652 participants, 388 (59.5%) were men and 264 (40.5%) were female. The prevalence of diabetes was significantly lower for men than for women in the whole sample (13.9% vs. 28.4%, χ² = 20.8, p < 0.001). However, there were no age-group differences in the prevalence of diabetes in either men or women. Compared to those without diabetes, men and women with diabetes were more likely to have high blood pressure (men: 51.9% vs. 36.5%; women: 50.7% vs. 36.7%). Women with diabetes were more

Discussion

The present research shows that sex and age differences should be considered when understanding the relationships between diabetes and functional impairments in older adults. Women in the younger old group with diabetes were at higher risk for functional impairment than their counterparts without diabetes in three of nine physical function tasks and in three of five higher functioning tasks. However, women in the older old group with diabetes were only at higher risk in two of the nine physical

Conclusion

Based on data from an Eastern population, Taiwan, the current study found gender and age differences in the relationship between of diabetes and functional impairment. Even after adjustment for age, education, and co-morbidities, men with diabetes were about four times more likely to have difficulties related to self-care impairment; while women with diabetes were about two to three times as likely to have difficulties related to higher functioning impairment, than their non-diabetic

Conflict of interest statement

None.

Acknowledgements

The descriptions or conclusions herein do not represent the viewpoint of the Bureau of Health Promotion, Department of Health, Taiwan.

References (15)

K.-T. Chen et al.
Prevalence of type 2 diabetes mellitus in Taiwan, ethnic variation and risk factors
Diabetes Res. Clin. Pract.
(2001)
Bureau of Health Promotion, Department of Health 2000. Results from the social environment and biomarkers of aging...
R.-C. Chia et al.
Attitudes toward women in Taiwan and China: current status, problems, and suggestions for future research
Psychol. Women Q.
(1997)
K.-L. Chou et al.
Functional disability related to diabetes mellitus in older Hong Kong Chinese adults
Gerontology
(2005)
Department of Health Taiwan
Health statistics in Taiwan 2006. Part II, Statistic on cause of death
E.W. Gregg et al.
Diabetes and physical disability among older U.S. adults
Diabetes Care
(2000)
J. Liang et al.
Gender differences in functional status in middle and older age: are there any age variations?
J. Gerontol. B: Psychol. Sci. Soc. Sci.
(2008)

There are more references available in the full text version of this article.

Cited by (13)

Health-related quality of life, medical resource use and physical function in patients with diabetes mellitus and depression: A cross-sectional analysis from the National Health and Nutrition Examination Survey
2023, Journal of Affective Disorders
Patients with either diabetes (DM) or depression (DP) are prone to developing other diseases and require more medical resources than do the general population. This study aimed to examine health-related quality of life, medical resource use, and physical function of patients with both diabetes mellitus and depression, and the magnitude of effects among patients with different combinations of comorbid diseases.
A retrospective cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 2009 to 2014. Total 16,159 patients were studied and classified into one of 4 groups: both DM and DP(DM+/DP+), DM+/without DP(DP−), without DM (DM−)/DP+, and DM−/DP−, according to the perceived score in Patient Health Questionnaire and diabetes questionnaire in NHANES. Health-related quality of life (HRQoL), medical resource use, and physical function were measured as outcomes of interests. Multivariate logistic regression models were used.
Compared with DM−/DP− patients, the DM+/DP+ (adjusted odds ratio [AOR]: 2.59; 95 % CI: 1.77–3.80) and DM−/DP+ (AOR: 2.44; 95 % CI: 1.94–3.06) had greater likely to have worse health. In addition, the DM+/DP+ (AOR: 5.40; 95 % CI: 1.30–22.41) and DM+/DP− (AOR: 2.49; 95 % CI: 1.91–3.25) were more likely to have medical visits, and worse physical function.
This study found that both depression and diabetes mellitus worsen HRQoL, increase medical resource use, and decrease physical function. Depression status should be considered by clinicians treating diabetes mellitus patients in order to improve their HRQoL, reduce medical resource use, and improve physical function.
Active engagement in social groups as a predictor for mental and physical health among Taiwanese older adults: A 4-year longitudinal study
2015, International Journal of Gerontology
Citation Excerpt :
The present study was approved by the Institutional Review Boards of the Bureau of Health Promotion (Health Promotion Administration, Ministry of Health and Welfare), Taipei City, Taiwan. Because previous studies have found major differences in older men and women14, sex was used as a grouping variable in subsequent analyses. The frequency of participation in social activities was measured in the 1999 TLSA.
The present research evaluated the long-term effects of late-life social participation on health conditions during 1–4 years among older adults in Taiwan.
Included in this study were adults older than 65 years who were interviewed in the 1999 fourth-wave Taiwan Longitudinal Study on Aging (TLSA), re-interviewed 1 year later in the Social Environment and Biomarkers of Aging Study, and interviewed 4 years later in the fifth-wave TLSA.
Participation in social groups demonstrated a positive effect on decreasing the risk of developing depressive symptoms in older Taiwanese females 4 years later, regardless of the influences of demographic characteristics and previous health conditions.
Social participation emerged to benefit later mental health among active older female adults. Active participation in social groups should therefore be strongly recommended for maintaining health in old age.
Diabetes and risk of physical disability in adults: A systematic review and meta-analysis
2013, The Lancet Diabetes and Endocrinology
Citation Excerpt :
Most studies were cross-sectional, nine were longitudinal, and one was a case-control study (table). Although the study of Wu and colleagues12 was longitudinal, we only included the results from their cross-sectional analysis of their baseline data because their longitudinal data reported change in disability status over time, not the risk of incident disability from diabetes.57 Length of follow-up in the longitudinal studies ranged from 18 months11 to 9 years.10
According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk.
We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability—as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility—in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]).
Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1·71, 95% CI 1·53–1·91; RR 1·51, 95% CI 1·38–1·64), of IADL disability (ten studies; OR 1·65, 95% CI 1·55–1·74), and of ADL disability (16 studies; OR 1·82, 95% CI 1·63–2·04; RR 1·82, 95% CI 1·40–2·36).
Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes.
Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.
Association between muscle strength and metabolic syndrome in older Korean men and women: The Korean Longitudinal Study on Health and Aging
2012, Metabolism: Clinical and Experimental
Citation Excerpt :
The sample size (n = 647) gives to a linear model greater than 90% power to detect a coefficient of determination greater than 6% with 10 parameters. The interaction between MS and age on muscle strength was verified, and then we further divided men into younger old (65-74 years) and older old (≥75 years) age groups according to the previous studies [36]. We used a generalized linear mixed (GLM) model approach to fit the models assessing the relationship between MS and muscle strength after adjusting for possible covariates.
The objective of the study was to investigate the association between metabolic syndrome (MS) and muscle strength in community-dwelling older men and women in Korea. Korean men and women 65 years and older living in a single, typical South Korean city (n = 647) were enrolled in the Korean Longitudinal Study on Health and Aging study. The diagnosis of MS was evaluated according to the definition of the National Cholesterol Education Program Adult Treatment Panel III. Isokinetic muscle strength of the knee extensors, as determined by peak torque per body weight (newton meter per kilogram) and hand-grip strength per body weight (newton per kilogram), was measured. Participants without MS had greater leg muscle strength and grip strength per weight. The effect of MS on muscle strength was more prominent in men than in women in our study population. Only men showed a significant interaction between MS and age for muscle strength (P = .014), and the effect was greater in men aged 65 to 74 years compared with those older than 75 years (119.2 ± 31.2 vs 134.5 ± 24.3 N m/kg). Participants with MS had weaker knee extensor strength after controlling the covariates (β = −90.80, P = .003), and the interaction term (age × MS × male sex) was significant (β = 1.00, P = .017). Metabolic syndrome is associated with muscle weakness, and this relationship is particularly pronounced in men. Age can modify the impact of MS on muscle strength. Men aged 65 to 74 years with MS need a thorough assessment of muscle strength to prevent disability.
Trends in the prevalence of physical and functional disability among Spanish elderly suffering from diabetes (2000-2007)
2011, Diabetes Research and Clinical Practice
Citation Excerpt :
The main finding of this study was the higher prevalence of disability – ADL, IADL and MD among Spanish elderly with diabetes when compared with non-sufferers. Our study confirms the greater risk of disability among diabetes sufferers, independently of the presence of any other co-morbidity, as reported in several studies [3,5–7]. We also found, among diabetic elderly, an increasing time trend from 2000 to 2007 for IADL and MD, a result in line with previously reported results [3–6,10–12].
We examined trends and associated factors of disability among Spanish elderly with diabetes from data of three National Health Surveys (NHS) from 2000 to 2007. Prevalence of disability was higher among diabetic elderly versus non-sufferers and increased over time. Adjusted OR for activities of daily living 1.66 (1.37–2.00); instrumental activities of daily living 1.52 (1.31–1.77) and mobility disability 1.7 (1.45–1.98).
Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes: A cross-sectional questionnaire survey
2011, International Journal of Nursing Studies
Since psychosocial issues appear to be common among people with diabetes, addressing these problems may improve outcomes. Specifically, it is important to understand the factors associated with anxiety and depression in patients with diabetes.
The purpose of this study was to investigate the relationships between self-care behaviour, diabetes education difficulties, depression and anxiety among patients with type-2 diabetes in Taiwan.
This study was cross-sectional and consisted of descriptive statistics and correlations in terms of analyses.
Three teaching hospitals, one from each of the northern, middle and southern parts of Taiwan, were selected for data collection.
A total of 312 patients diagnosed with type-2 diabetes were recruited to participate in this study. The inclusion criteria of the study subjects included a diagnosis of type-2 diabetes beyond the age of 18 years and the ability to communicate in Mandarin.
Various questionnaires were used to assess demographic, disease characteristics, self-care behaviour, diabetes education difficulty, depression and anxiety data.
(1) Rates of disturbance for depression (10.6%) and anxiety (20.5%) among type-2 diabetes patients were lower than those in Western countries. (2) Anxiety was positively correlated with age (r = 0.15, p < 0.01), complications (r = 0.27, p < 0.01), diabetes education difficulty (r = 0.39, p < 0.01) and depression (r = 0.54, p < 0.01), but negatively correlated with body mass index (BMI) (r = 0.20, p < 0.01). (3) A total of 50.5% of variance in anxiety was explained by age, complications, BMI, diabetes education difficulty and depression. (4) A total of 42.8% of variance in depression was explained by BMI, diabetes education difficulty and anxiety.
Depression and anxiety are common among patients with diabetes and can have significant effects on the outcome of their medical illness. Addressing psychosocial factors of people with diabetes may improve effects of patient education and disease self-management.

View all citing articles on Scopus

View full text

Diabetes mellitus and functional impairment in Taiwanese older men and women

Abstract

Introduction

Section snippets

Study population

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgements

Diabetes Res. Clin. Pract.

Attitudes toward women in Taiwan and China: current status, problems, and suggestions for future research

Psychol. Women Q.

Functional disability related to diabetes mellitus in older Hong Kong Chinese adults

Gerontology

Health statistics in Taiwan 2006. Part II, Statistic on cause of death

Diabetes and physical disability among older U.S. adults

Diabetes Care

Gender differences in functional status in middle and older age: are there any age variations?

J. Gerontol. B: Psychol. Sci. Soc. Sci.