Type 1 diabetes (T1D) is associated with numerous complications, which may in turn cause significant disability. However, little evidence is available on the proportion of T1D patients affected by disability in the U.S. We thus assessed incidence and predictors of disability in a childhood onset T1D cohort (n=658, mean baseline age, 28 and diabetes duration, 19 years) during a 25 year follow-up. Disability was assessed via self-report in response to the question: “Do you have any disabilities that limit the type or amount of work you can do at home, school or on the job?” Of 509 free of disabilities at baseline, 49.7% (n=253) reported a disability during follow-up. Incident cases were more likely to be older at baseline, with longer diabetes duration, higher HbA1c, non-HDLC, triglycerides, and albumin excretion rate (AER). They were also more likely to be women, current smokers, have hypertension, depressive symptoms (Beck Depression Inventory), and prevalent complications (i.e., cardiac autonomic neuropathy, proliferative retinopathy (PR), distal symmetric neuropathy (DSP), lower extremity arterial disease, and increased albuminuria). In multivariable Cox models, independent predictors of disability incidence comprised diabetes duration (HR=1.05, 95% CI: 1.02-1.07), female sex (1.99, 1.46-2.72), current smoking (1.40, 0.99-1.97), HbA1c (1.24, 1.12-1.38), non-HDLC (1.007, 1.003-1.011), log AER (1.12, 1.03-1.23), DSP (1.59, 1.10-2.29), coronary artery disease (1.84, 1.00-3.38) and depressive symptoms (mild/moderate HR=1.38 (0.98-1.94); moderate/severe HR=2.25 (1.24-4.09)). The addition of depressive symptoms to models including traditional risk factors and complication status significantly enhanced the prediction of incident disability (Uno’s concordance statistic p=0.02).
In conclusion, modifiable risk factors, depressive symptoms and diabetes complications predicted disability incidence, which affected almost half of this T1D cohort.
T. Costacou: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.
National Institutes of Health (DK34818); Rossi Memorial Fund