[ Nutrition ]

Age Adds to Diabetes Disability Burden

This is a retrospective cohort study using VHA and Medicare files of VHA clinic users with diabetes. Diabetes can have a serious effect on a persons health; particularly if they are recently diagnosed and still trying to get their condition under control. RESEARCH DESIGN AND METHODS—In a cohort of diabetic individuals (n = 1,642) enrolled in a large health maintenance organization, excluding homemakers and retirees, we assessed the relation of diabetes severity, chronic disease comorbidity, depressive illness, and behavioral risk factors with work disability. Researchers from Baker IDI Heart and Diabetes Institute in Melbourne, Australia analyzed 26 studies and found that diabetics with either type 1 or type 2 who were 65 and older were between a 50 and 80 percent higher risk of developing a physical disability that left them with impaired mobility or unable to complete everyday tasks, such as bathing, eating or using the phone. Overall, the quality of the evidence on which to base prevention and management strategies is variable. Mr Stoute brought a claim of disability discrimination against his former employer. Data represent the U.S.

Cox proportional regression analyses showed that diabetic participants were more likely to report any limitation in lower body ADL function (hazard ratio [HR] = 2.05, 95% confidence interval [CI], 1.58-2.67), mobility tasks (HR = 1.69, 95% CI, 1.39-2.04), and 8-foot walk (HR = 1.46, 95% CI, 1.15-1.85) compared with nondiabetic participants, after controlling for relevant factors. Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. The risk increased by 30% among people who used antidepressant medications after adjustment for other risk factors for diabetes and history of hypertension and high cholesterol. With a disease such as diabetes, additional financial support can be the critical factor that may prevent or delay the development of potentially disabling complications. This is one reason – among dozens – that I believe that the C-File is the most important document in your VA disability compensation claim. Additionally, a case-control study showed a two-and-one-tenth-fold increased odds of disabled mobility with diabetes. The pooled data between the types of studies showed a 71% increased odds of disabled mobility (95% CI 1.53-1.91) among patients with diabetes, with a relative increased risk of 51% versus those without diabetes.

An accompanying editorial by Edward Gregg, PhD, of the National Center for Chronic Disease Prevention and Health Promotion in Atlanta, noted that there were a number of “deficits of the evidence base related to diabetes and disability that could affect prevention strategies.” These included a lack information on which mechanisms lead to functional decline and in what ways they are explained by vascular complications, and whether therapeutic approaches make a difference; also, if associations in the opposite direction affect the relationship and how diabetes may affect younger patients. It was noted that an appeal was the only means by which the employer could seek to set aside the tribunal’s decision. Only for eight participants the diagnoses were made using glycohemoglobin level.

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