Diabetes Linked to Lower Life Expectancy, More Disability

Veronica Hackethal, MD

April 18, 2016

Women and men with both types of diabetes have lower overall life expectancy and spend more time living with disability than people without diabetes, according to a new study.

"From the age of 50, people with diabetes spend about 60% of their remaining life living with disability, compared with only 40% for people without diabetes," lead author Dianna Magliano, MPH, PhD, associate professor at the Baker IDI Heart and Diabetes Institute, Melbourne, Australia, said in an email to Medscape Medical News.

"We estimate that the loss of life expectancy from age 50 will be about 3 years for both men and women with diabetes compared with those without," she added. Eliminating diabetes in the entire population of people with and without diabetes at age 50 would result in a gain in life expectancy of 0.6 years and a gain in disability-free life expectancy of 1.8 years.

Dr Magliano and colleagues published their findings online April 14 in Diabetologia.

The research also found that women with diabetes spend a larger proportion of their lives living with disability compared with men with diabetes and women without diabetes.

Women with diabetes at age 50 may expect to live another 34 years, but they may spend 21 of those years, on average, living with disability. Men with diabetes at age 50 may live another 30 years and spend a mean of 17.3 of those years living with disability, according to Dr Magliano.

Quality of Life in Diabetes Now in the Spotlight

Diabetes affects about 415 million people worldwide, with rates continuing to climb. Over the past 3 decades prevalence has doubled, with experts now predicting that over one-third of young adults will develop diabetes during their lifetimes.

Advances in treatment have contributed to increased longevity among people living with diabetes and brought quality-of-life issues into the spotlight.

While people with both types of diabetes have experienced gains in life expectancy, they still lag behind those without diabetes. Two recent studies, one from Australia and another from Sweden, found that people with type 1 diabetes have a life expectancy that is still 12 years below that of the general population.

In this latest work, Dr Magliano and colleagues obtained 2011 mortality data by linking the National Diabetes Services Scheme, which includes 80% to 90% of Australians with known diabetes, to the National Death Index (NDI) and standard national mortality data for the general population.

They extracted data on disability prevalence from the 2012 Australian Survey of Disability, Aging, and Carers (SDAC) survey. And diabetes prevalence figures came from the nationally representative Australian Diabetes, Obesity, and Lifestyle study.

Researchers estimated life expectancy and disability-free life expectancy for women and men who had diabetes at age 50 and compared these with their nondiabetic counterparts.

Diabetic Women More Adversely Affected by Disability Than Men

The results showed that women with diabetes had an estimated lifetime expectancy of 33.9 years at age 50. They had an estimated loss in life expectancy of 3.1 years compared with women without diabetes.

Men with diabetes had an estimated life expectancy of 30.2 years at age 50. They had an estimated loss in life expectancy of 3.2 years compared with men without diabetes.

The findings also showed that people with diabetes spent a much larger proportion of their lives living with disability compared with nondiabetics.

Women with diabetes had an estimated disability-free life expectancy of 13.1 years at age 50 and spent 61.4% of their total remaining life expectancy living with disability. This latter proportion was 40% for women without diabetes.

Men with diabetes had an estimated disability-free life expectancy of 12.7 years at age 50 and spent 58% of their total remaining life expectancy living with disability. This proportion was 37.5% for men without diabetes.

Women with diabetes had an estimated loss in disability-free life expectancy of 9.1 years compared with 8.2 years for men with diabetes.

The fact that women have a longer life expectancy and a higher prevalence of disability may largely explain the sex differences found in this study, along with the fact that women may also be more likely to report disability than men, according to Dr Magliano.

The study could not distinguish between type 1 and type 2 diabetes.

Type 1 diabetes typically has an earlier age of onset than type 2 diabetes and may incur more complications and a higher risk of disability. Furthermore, the authors point out that the estimates from this study should not be used to predict life expectancy and disability-free life expectancy across the board, because mortality and disability change with time.

More Work Needed to Understand Disability in Diabetes

Dr Magliano said the understanding "of how physical disability develops [in diabetes] is currently quite limited" but is probably multifactorial.

Comorbidities and poor glycemic control may increase diabetic complications like diabetic retinopathy, potentially leading to blindness, and diabetic neuropathy, leading to amputations, which contribute to disability. Cognitive impairment and loss of muscle mass may also play a role.

"We need to undertake research that will elucidate the mechanisms by which diabetes leads to disability," she concluded.

"This will then help the development of intervention strategies to prevent the onset of disability in diabetes, which in turn may lead to more years lived disability-free."

This study was funded by the National Health and Medical Research Council and the Australian Research Council and partly funded by the Victorian Operational Infrastructure Program scheme. The authors report no relevant financial relationships.

Diabetologia. Published online April 14 2016. Abstract

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