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Not Only Diabetes but Also Prediabetes Leads to Functional Decline and Disability in Older Adults

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posted on 15.01.2021, 00:58 by Ying Shang, Laura Fratiglioni, Davide Liborio Vetrano, Abigail Dove, Anna-Karin Welmer, Weili Xu
BACKGROUND: 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 followed 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 diabetes-free participants. CVDs were ascertained through clinical examinations and the National Patient Registry. 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 multi-adjusted mixed effect models, prediabetes was associated with an increased chair stand time (0.33, 95% CI 0.05 to 0.61), a decreased walking speed (-0.006, -0.010 to -0.002), and an accelerated disability progression (0.05, 95% CI 0.01 to 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.


The SNAC-K ( is financially supported by the Swedish Ministry of Health and Social Affairs; the participating county councils and municipalities; the Swedish Research Council; and the Swedish Research Council for Health, Working Life and Welfare. In addition, W.X. also received grants from the Swedish Research Council (No 2017-00981), the National Natural Science Foundation of China (No. 81771519), and the Konung Gustaf V:s och Drottning Victorias Frimurare Foundation (No. 2016-2017). Y.S. also received grants from the China Scholarship Council (No. 201600160093) and the Swedish National Graduate School on Aging and Health. Finally, this project is part of the CoSTREAM ( and received funding from the European Union’s Horizon 2020 research and innovation program (No. 667375).