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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

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posted on 26.07.2022, 12:04 authored by Catherine L. Martin, Victoria R. Trapani, Jye-Yu C. Backlund, Pearl Lee, Barbara H. Braffett, Ionut Bebu, John M. Lachin, Alan M. Jacobson, Rose Gubitosi-Klug, William H. Herman, the DCCT/EDIC Research Group

  

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 multi-center, 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 assessed associations of both outcomes with demographic and clinical factors (glycemic and non-glycemic factors, micro- and macrovascular complications, DCCT cohort and treatment assignment)

Results: Fifty-three percent of participants were male. The mean age was 59.5±6.8 years and mean diabetes duration was 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 DCCT/EDIC mean 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 if these findings are generalizable.

Funding

The DCCT/EDIC has been supported by cooperative agreement grants (1982-1993, 2012-2017, 2017-2022), and contracts (1982-2012) with the Division of Diabetes Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Disease (current grant numbers U01 DK094176 and U01 DK094157), and through support by the National Eye Institute, the National Institute of Neurologic Disorders and Stroke, the General Clinical Research Centers Program (1993-2007), and Clinical Translational Science Center Program (2006-present), Bethesda, Maryland, USA.

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