Abstract
Background
Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without.
Aims
Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants.
Methods
A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored.
Results
Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42–7.56), history of stroke (OR 4.58, 95% CI 1.64–12.7), and greater IADL dependency (OR 1.08 95% CI 1.02–1.15).
Discussion
Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related.
Conclusion
Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data cannot be shared publicly because there was no such approval in the study protocol. The datasets used and analyzed during the study are available from the corresponding author upon reasonable request and subject to ethical approval request.
References
Formiga F, Ferrer A, Padrós G et al (2014) Diabetes mellitus as a risk factor for functional and cognitive decline in very old people: the Octabaix study. J Am Med Dir Assoc 15:924–928. https://doi.org/10.1016/j.jamda.2014.07.019
Gómez-Huelgas R, Gómez Peralta F, Rodríguez Mañas L et al (2018) Treatment of type 2 diabetes mellitus in elderly patients. Rev Clin Esp (Barc) 218:74–88. https://doi.org/10.1016/j.regg.2017.12.003
de Rekeneire N, Volpato S (2015) Physical function and disability in older adults with diabetes. Clin Geriatr Med 31:51–65. https://doi.org/10.1016/j.cger.2014.08.018
Tsai YH, Chuang LL, Lee YJ et al (2021) How does diabetes accelerate normal aging? An examination of ADL, IADL, and mobility disability in middle-aged and older adults with and without diabetes. Diabetes Res Clin Pract 182:109–114. https://doi.org/10.1016/j.diabres.2021.109114
Bardenheier BH, Lin J, Zhuo X et al (2016) Disability-free life-years lost among adults aged ≥50 years with and without diabetes. Diabetes Care 39:1222–1229. https://doi.org/10.2337/dc15-1095
Formiga F, Reñe R, Pérez-Maraver M (2015) Dementia and diabetes: casual or causal relationship? Med Clin (Barc) 144:176–180. https://doi.org/10.1016/j.medcli.2014.01.026
Xue M, Xu W, Ou YN et al (2019) Diabetes mellitus and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 144 prospective studies. Ageing Res Rev 55:100944. https://doi.org/10.1016/j.arr.2019.100944
Corsonello A, Tap L, Roller-Wirnsberger R et al (2018) Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study. BMC Nephrol 19:260. https://doi.org/10.1186/s12882-018-1030-2
Moreno-Gonzalez R, Corbella X, Mattace-Raso F et al (2020) Prevalence of sarcopenia in community-dwelling older adults using the updated EWGSOP2 definition according to kidney function and albuminuria: the screening for CKD among older people across Europe (SCOPE) study. BMC Geriatr 20:327. https://doi.org/10.1186/s12877-020-01700-x
Wong E, Backholer K, Gearon E et al (2013) Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 1:106–114. https://doi.org/10.1016/S2213-8587(13)70046-9
Freedman VA, Wolf DA, Spillman BC (2016) Disability-free life expectancy over 30 years: a growing female disadvantage in the US population. Am J Public Health 106:1079–1085. https://doi.org/10.2105/AJPH.2016.303089
Maggi S, Noale M, Gallina P et al (2004) Physical disability among older Italians with diabetes. The ILSA Study. Diabetologia 47:1957–1962. https://doi.org/10.1007/s00125-004-1555-8
Gregg EW, Mangione CM, Cauley JA et al (2002) Diabetes and incidence of functional disability in older women. Diabetes Care 25:61–67. https://doi.org/10.2337/diacare.25.1.61
Kautzky-Willer A, Harreiter J, Pacini G (2016) Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev 37:278–316. https://doi.org/10.1210/er.2015-1137
Gong J, Harris K, Hackett M et al (2021) Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial. Diabetes Obes Metab 23:1775–1785. https://doi.org/10.1111/dom.14391
Chatterjee S, Peters SA, Woodward M et al (2016) Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39:300–307. https://doi.org/10.2337/dc15-1588
Bossoni S, Mazziotti G, Gazzaruso C et al (2008) Relationship between instrumental activities of daily living and blood glucose control in elderly subjects with type 2 diabetes. Age Ageing 37:222–225. https://doi.org/10.1093/ageing/afm158
Ek S, Rizzuto D, Xu W et al (2021) Predictors for functional decline after an injurious fall: a population-based cohort study. Aging Clin Exp Res 33:2183–2190. https://doi.org/10.1007/s40520-020-01747-1
Grande G, Vetrano DL, Fratiglioni L et al (2020) Disability trajectories and mortality in older adults with different cognitive and physical profiles. Aging Clin Exp Res 32:1007–1016. https://doi.org/10.1007/s40520-019-01297-1
Acknowledgements
We thank CERCA Programme/Generalitat de Catalunya and Hospital Universitari de Bellvitge/Institut Català de la Salut for institutional support. We thank the BioGer IRCCS INRCA Biobank for the collection of the SCOPE samples. SCOPE study investigators: Consortium centers and members: Geriatric Unit, Internal Medicine Department and Nephrology Department, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain: Francesc Formiga, Rafael Moreno-González, David Chivite, Yurema Martínez, Carolina Polo, Josep Maria Cruzado. Coordinating center, Fabrizia Lattanzio, Italian National Research Center on Aging (INRCA), Ancona, Italy—Principal Investigator. Andrea Corsonello, Silvia Bustacchini, Silvia Bolognini, Paola D’Ascoli, Raffaella Moresi, Giuseppina Di Stefano, Cinzia Giammarchi, Anna Rita Bonfigli, Roberta Galeazzi, Federica Lenci, Stefano Della Bella, Enrico Bordoni, Mauro Provinciali, Robertina Giacconi, Cinzia Giuli, Demetrio Postacchini, Sabrina Garasto, Annalisa Cozza—Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy—Coordinating staff. Romano Firmani, Moreno Nacciariti, Mirko Di Rosa, Paolo Fabbietti—Technical and statistical support. Department of Medical Sciences, Uppsala University, Sweden: Johan Ärnlöv, Axel Carlsson, Tobias Feldreich. Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, The Netherlands: Francesco Mattace-Raso, Lisanne Tap, Gijsbertus Ziere, Jeannette Goudzwaard. Departments of Geriatrics and Gerontology, Healthy Ageing Research Centre, Medical University of Lodz, Poland: Tomasz Kostka, Agnieszka Guligowska, Łukasz Kroc, Bartłomiej K Sołtysik, Małgorzata Pigłowska, Agnieszka Wójcik, Zuzanna Chrząstek, Natalia Sosowska, Anna Telążka, Joanna Kostka. Department of General Internal Medicine and Geriatrics, Krankenhaus Barmherzige Brüder Regensburg and Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany: Christian Weingart, Ellen Freiberger, Cornel Sieber. Department of Internal Medicine, Medical University of Graz, Austria: Gerhard Hubert Wirnsberger, Regina Elisabeth Roller-Wirnsberger, Carolin Herzog, Sonja Lindner. The Recanati School for Community Health Professions at the faculty of Health Sciences at Ben-Gurion University of the Negev, Israel: Rada Artzi-Medvedik, Yehudit Melzer, Mark Clarfield, Itshak Melzer; and Maccabi Healthcare services southern region, Israel: Rada Artzi-Medvedik, Ilan Yehoshua, Yehudit Melzer. Department of Geriatric Medicine, Hospital Clínico San Carlos, Madrid, Spain: Pedro Gil Gregorio, Sara Laínez Martínez, Monica González Alonso, Jose A. Herrero Calvo, Fernando Tornero Molina, Lara Guardado Fuentes, Pamela Carrillo García, María Mombiedro Pérez.
Funding
The SCOPE project was granted by the European Union Horizon 2020 program, under the Grant Agreement n° 634869.
Author information
Authors and Affiliations
Consortia
Contributions
FF, AMBT, and RMG participated in study protocol design, data collection, and drafting of the manuscript. AC, PF, and FL conceived the study, coordinated study protocol and data collection, participated in manuscript revision and approval. FF participated in data analysis, manuscript drafting, and revision. JÄ, AC, FMR, LT, TK, AG, CCS, RK, RB-R, IY, RR-W GW, participated in study protocol design, data collection, and manuscript revision and approval. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Ethical approval
The study protocol was approved by ethics committees at all participating institutions, and complies with the Declaration of Helsinki and Good Clinical Practice Guidelines. Ethics approval has been obtained by Ethics Committees in participating institutions as follows: Italian National Research Center on Aging (INRCA), Italy, #2015 0522 IN, 27 January 2016. University of Lodz, Poland, #RNN/314/15/KE, 17 November 2015. Medizinische Universität Graz, Austria, #28–314 ex 15/16, 5 August 2016. Erasmus Medical Center Rotterdam, The Netherland, #MEC-2016-036-#NL56039.078.15, v.4, 7 March 2016. Hospital Clínico San Carlos, Madrid, Spain, # 15/532-E_BC, 16 September 2016 Bellvitge University Hospital Barcellona, Spain, #PR204/15, 29 January 2016. Friedrich-Alexander University Erlangen-Nürnberg, Germany, #340_15B, 21 January 2016. Helsinki committee in Maccabi Healthcare services, Bait Ba-lev, Bat Yam, Israel, #45/2016, 24 July 2016.
Informed consent
The informed consent was signed by the subject or a close relative. All methods were performed in accordance with relevant guidelines and regulations.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Formiga, F., Badía-Tejero, A.M., Corsonello, A. et al. Diabetes and factors associated with cognitive and functional decline. The screening for CKD among older people across Europe (SCOPE) study. Aging Clin Exp Res 35, 2693–2701 (2023). https://doi.org/10.1007/s40520-023-02536-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-023-02536-2