Association between type 2 diabetes mellitus and disability: What is the contribution of diabetes risk factors and diabetes complications?

Background The aim of this study was to evaluate the association between type 2 diabetes and disability in Mauritius and to assess the extent to which the effect of diabetes is explained by diabetes risk factors and concomitant complications. Methods Data from a national survey in the multiethnic nation of Mauritius, which comprises South Asians and African Creoles, were analyzed. Disability was measured using the Katz activities of daily living questionnaire in participants aged >50 years. Results Among 3692 participants, 487 (13.2%) had some level of disability. Diabetes was associated with significantly higher risk of disability (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.34–2.08). After adjusting for demographic, behavioral, and metabolic factors, as well as comorbidities, disability was significantly associated with diabetes among African Creoles (OR 2.03; 95% CI 1.16–3.56), but not South Asians (OR 1.27; 95% CI 0.98–1.66). Obesity explained much of the association between diabetes and disability (excess percentage of risk: 26.3% in South Asians and 12.1% in African Creoles). Obesity, history of cardiovascular disease (CVD), asthma‐like symptoms, and depression together explained 46.5% and 29.0% of the excess risk in South Asians and African Creoles, respectively. Conclusions Diabetes is associated with a 67% increased risk of disability. Diabetes risk factors and comorbidities explain more of the association between diabetes and disability among South Asians than Africans. Obesity and history of CVD explained the largest percentage of the relationship between diabetes and disability, indicating that weight and CVD management may be helpful in controlling disability related to diabetes. 摘要 背景 本研究的目的是在毛里求斯调查2型糖尿病与残疾之间的关系, 并且通过糖尿病危险因素以及伴随的并发症来评估糖尿病对残疾的影响程度。 方法 分析所用的数据来源于一项在毛里求斯这个多种族(包括南亚人与非洲克理奥尔人)国家中进行的全国性调查研究。在年龄> 50岁的参与者中通过使用日常生活调查表测定卡茨活动量(Katz activities)来评定残疾程度。 结果 在3692名参与者中, 487名(13.2%)合并有不同程度的残疾。糖尿病与残疾风险显著升高相关(优势比[OR]为1.67;95% 置信区间[CI]为1.34–2.08)。在非洲克理奥尔人中, 校正人口统计学数据、行为与代谢因素以及合并症后, 发现残疾与糖尿病显著相关(OR为2.03;95% CI为1.16‐3.56), 但是在南亚人中却没有相关性(OR为1.27;95% CI为0.98‐1.66)。糖尿病与残疾之间的关系大部分可以用肥胖来解释(超出风险的百分比:南亚人中肥胖占26.3%, 非洲克理奥尔人中肥胖占12.1%)。在南亚人与非洲克理奥尔人中, 超出的风险中分别有46.5%与29.0%可以用肥胖、心血管疾病史、哮喘样症状以及抑郁症共同解释。 结论 糖尿病可导致残疾的风险增加67%。在南亚人中糖尿病与残疾之间的关系与在非洲人中相比更多地可以用糖尿病危险因素以及合并症来解释。糖尿病与残疾之间的关系绝大部分可以用肥胖以及心血管疾病史来解释, 这意味着积极管理体重与心血管疾病史可能有助于减少糖尿病相关的残疾。 Highlights Diabetes is associated with 67% increased odds of disability. The prevalence of disability is higher am