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Low well-being, cognitive impairment and visual impairment associated with functional disabilities in elderly Japanese patients with diabetes mellitus


Dr Atsushi Araki, MD, PhD, Department of Endocrinology, Tokyo Metropolitan Geriatric Medical Center, 35–2 Sakae-cho, Tokyo 173–0015, Japan. Email:


Background:  The objective of this study is to examine the important factors associated with functional disabilities in elderly patients with diabetes mellitus.

Methods:  This was a multicenter cross-sectional study. A total of 1135 elderly diabetic outpatients aged over 65 years in 10 hospitals participated in our study. Functional disabilities were assessed with questionnaires on the instrumental activity of daily livings (IADL), intellectual activity and social role using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Cognitive function and well-being were assessed by the mini-mental state examination and morale scale, respectively.

Results:  The patients were divided into three age groups. The oldest (≥ 80 years) group reported significant high prevalence of functional disabilities (10% to 36%) compared to the youngest (65–69 years) group (4% to 20%). The number of vascular complications (≥ 4) was associated with a 5.5–8.8 fold increased risk of disabilities relating to the tasks on IADL (using public transportation, shopping, preparing meals and paying bills). Using multiple logistic regression analyses, low scores of morale scales (≤ 7) and mini-mental state examination (≤ 23) were significantly associated with disabilities on the IADL, intellectual activity and social role after adjustment for age, gender, BMI, duration of diabetes, HbA1c, insulin treatment, microangiopathy and macroangiopathy. Insulin treatment and low visual acuity were also associated with the IADL after adjustment for the other variables.

Conclusions:  Older age, insulin treatment, low well-being, cognitive impairment, and visual impairment were independently associated with the functional disabilities of elderly patients with diabetes mellitus.

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