Highlights From the Latest in Diabetes Research

Ample evidence supports the role of diabetes in increasing risk for both largeand small-vessel complications, as well as reducing quality of life and increasing health care costs. It has also been demonstrated that diabetes is associated with lower levels of physical function among middle-aged and older adults. The relationship between diabetes and disability can be viewed against the larger backdrop of the aging of the U.S. population and the role that disability plays in nursing home admission and loss of independence in the community. In an analysis of data from the Look AHEAD study, Rejeski et al. provide insight into what can be done to modify the trajectory of diabetes-associated mobility disability among community-dwelling adults. Look AHEAD participants included >5,000 diabetic individuals aged 45–74 years who were randomly assigned either to intensive lifestyle targeting a 7% weight loss and 175 min of weekly physical activity or to a control group that received diabetes education and support. Self-reported mobility was assessed with questionnaire items that were used to construct a 4-level outcome describing participants’ mobility disability (good, mild, moderate, and severe). At 4 years, good mobility was present in 38.5 and 31.9% of intervention and control participants. Conversely, severe mobility disability was present in 20.6 and 26.2% of participants in the two groups. Tests of mediation were used to demonstrate that each 1% relative reduction in weight reduced the risk of mobility loss by 7.3% and that each 1% relative improvement in fi tness reduced this risk by 1.4%. Although the Look AHEAD study was originally designed to examine the impact of intensive lifestyle modifi cation on cardiovascular disease risk reduction among diabetic adults, Rejeski et al. have used this study vehicle to provide proof of concept that diabetes-associated disability can be favorably impacted by intensive lifestyle modifi cation. However, the Diabetes Prevention Program (DPP) showed that a similar intervention was effective in reducing the risk of diabetes among high-risk individuals, yet widespread, sustainable translation of the DPP’s resource-intensive methods has been elusive. The aging U.S. population will undoubtedly be impacted by diabetes-associated disability. A key challenge that lies ahead is identifying practical approaches to weight loss and fi tness that will help older diabetic adults remain independent in the community. — Helaine E. Resnick, PhD, MPH