Chronic Illness

Interference of diabetes with social activities may be an early warning sign of subsequent disability

The degree to which one's diabetes interferes with participation in social activities—for example, going to church, the movies, or on day or overnight trips—may be an early indicator of subsequent disability in daily functioning and premature death. This is the conclusion of a recent study supported by the Agency for Healthcare Research and Quality (HS11618). By asking older diabetes patients about their social activities, clinicians can identify those who will benefit most from interventions to stem the future loss of independence, according to investigators at the University of Texas Medical Branch, Galveston.

The researchers used data from the Medicare Health Outcomes Surveys in 1998 (baseline) and 2000 (followup) on physical and mental health functioning, activities of daily living (ADLs, such as dressing or bathing oneself or walking without assistance), and medical conditions on 8,949 elderly community-dwelling diabetes patients enrolled in the Medicare Managed Care program. Study subjects had no ADL disability at baseline. The researchers derived individual health-related social disengagement (degree to which physical health or emotional problems interfered with social activities) scores from the social functioning subscale of the Medical Outcomes Study Short Form-36 (SF-36).

For each 10-point increase in social functioning score at baseline, older diabetes patients experienced an 18 percent less chance of any ADL disability and a 12 percent less chance of death over a 2-year period, after adjusting for demographic factors, coexisting illnesses, depression, and general health. These findings suggest that even when no ADL disability is clinically evident, patients start, perhaps at an early presymptomatic stage of disability, to adjust their levels of social activities in response to their perceptions of physical and emotional disturbances.

Details are in "Health-related social disengagement in elderly diabetic patients," by Yong-Fang Kuo, Ph.D., Mukaila A. Raji, M.D., M. Kristen Peek, Ph.D., and James S. Goodwin, M.D., in the July 2004 Diabetes Care 27(7), pp. 1630-1637.

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