A study has found that older Americans with diabetes, particularly those who were born in the 1940s, are not only living longer but with fewer disabilities than those born a decade earlier.
The research, authored by Dr. Barbara Bardenheier from the US Centers for Disease Control & Prevention, examined trends in disabling years between two cohorts of the U.S. adults who had diabetes and were born in 1930s (1931–1941) and 1940s (1942–1947).
Dr. Bardenheier found that adults born in the 1940s had a delayed onset of disability and more disability-free years of life. Such adults experienced disability much later on in life, usually not before the age of 70. The study was published in The Lancet and did not distinguish between type 1 and type 2 diabetes.
“Over the past two decades, we have seen an increase in the length of good disability-free years of life in older Americans aged 50-70 both with and without diabetes,” says Dr. Barbara Bardenheier. Dr. Bardenheier believes that her findings are in line with the efforts and interventions that promote healthy lifestyles, advancements in the management of diabetes, and the ever-increasing availability of prosthetic procedures such as hip and knee replacements – all of which contribute to ‘compressing disability’ among adults with diabetes.
“The interventions have successfully reduced the number of years with disability into later years, up to age 70,” remarked Dr. Bardenheier.
While individual complications of diabetes, such as cardiovascular disease and kidney disease have been investigated and studied at length, there has been little research done on whether diabetes increases the risk of various types of disabilities. The recent study was an endeavor in this direction.
In this study, a team of US researchers analyzed data from the Health and Retirement Study for two cohorts of the U.S. adults aged 50-70 years. Of these adults, 1,367 had diabetes and 11,414 did not. The Health and Retirement Study is a nationally representative research and policymaking center that surveys more than 20,000 old Americans every two years.
The researchers noted and compared three types of disabilities between the cohorts, namely impaired mobility, less or compromised ability to perform daily activities (such as walking, bathing or eating) and reduced ability to carry out basic activities such as preparing meals, using the phone and shopping. The researchers also followed up closely for mobility-loss and death among the subjects.
Cohort 1 comprised of adults born in the 1930s who were followed from 1992 to 2002. Cohort 2 included subjects born in the 1940s who were followed from 2002 to 2012. The prime endpoint of the study was to determine and compare the number of years lived with and without disability by age 70 in both cohorts.
There was a healthy trend in both cohorts in terms of disability-free life years and compression of disability till age 50. However, people with diabetes in both cohorts exhibited a later onset of disability, fewer disabled years and more overall years of life. However, from age 50 onwards the trend shifted. As compared to people without diabetes, those who had diabetes exhibited a reduced life expectancy and greater numbers of years living with disability.
When a direct comparison between adults with diabetes born in two different decades was done, those who were born in the 1940s exhibited a delay in all types of disabilities and showed an increase in disability-free years of life. They also lived more years without disability prior to age 70. The findings were similar in both gender subjects.
However, the authors believe that the trend seen among the older people may not be replicated in the successive generations, given the increasing rate of obesity, alcohol consumption, unhealthy diets, physical inactivity and other such factors that complicate the disease.
The study had several limitations; for one there was a lack of data beyond age 70, which restricted the researchers to further investigate the disability that occurs later in life. Furthermore, the study did not assess several variants that could affect the outcomes in diabetes, such as obesity, high blood pressure, and physical activity (or lack thereof).
In the United States, the incidence and prevalence of type 2 diabetes has increased staggeringly over the last 20 years. Currently, there are over 21 million Americans with diabetes. Despite its prevalence, the vast majority of cases of type 2 diabetes in elderly population are actually preventable. The authors of the study believe that the primary prevention of diabetes and interventions to prevent its complications will continue to have the greatest impact on improving overall health.