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Quality of Life Versus Shorter Lives with Diabetes

According to a new study, people with diabetes have a slightly shorter life expectancy than people without diabetes, and many of those years will be marred by disability.

The purpose of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes.

Two methods were used to estimate LE and DFLE by age and sex. Mortality data in 2013 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2015 Australian Survey of Disability, Ageing and Carers (SDAC).

The results showed that the life expectancy and disability-free life expectancy (with 95% uncertainty interval [UI]) at age 50 years were 30.2 and 12.7 years, respectively, for men with diabetes, and the estimates were 33.9 and 13.1  years, respectively, for women with diabetes. The estimated loss of life expectancy associated with diabetes at age 50 years was 3.2 years for men and 3.1 years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 years for men and 9.1  years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in life expectancy and DFLE across the whole population at age 50 years after hypothetically eliminating diagnosed diabetes were 0.6 years and 1.8 years.

For women, those estimates were 33.9 (95% CI 33.6-34.1) and 13.1 (95% CI 12.3-13.9) years respectively.

Lead author Lili Huo, MD noted that, “The striking loss of disability-free life expectancy in diabetes reported in this study will most likely raise concern about the burden of diabetes in the future, indicating a need to respond by implementing intervention and prevention of disability.”

The authors said that a recent study found a 50-80% increase in the odds of having a physical disability in diabetes patients versus nondiabetic patients. They also found that the risk of all diabetes-related disabilities, including severe disabilities, increased with age.

In another study, they examined changes in life expectancy free of disability using data collected from 1984 through 2000 from two cohorts who composed the Longitudinal Studies of Aging I and II. Life expectancies with and without aging disabilities.  Aging disabilities were calculated using a Markov-based multistate life table approach. At age 70, disability-free life expectancy increased over a 10-year period by 0.6 of a year in the later cohort, which was the same as the increase in total life expectancy, with both increases marginally statistically significant. The average length of expected life with aging disabilities did not change. Changes in disability-free life expectancy resulted from decreases in disability incidence and increases in the incidence of recovery from disability across the two survey cohorts. Age-specific mortality among the ADL disabled declined significantly in the later cohort after age 80. Mortality for the ag- related disability and the nondisabled did not change significantly. Those with ADL disability at age 70 experienced substantial increases in both total life expectancy and disability-free life expectancy. These results indicate the importance of efforts both to prevent and delay disability and to promote recovery from disability for increasing life expectancy without disability. Results also indicate that while reductions in incidence and increases in recovery work to decrease population prevalence of disability, declining mortality among the disabled has been a force toward increasing disability prevalence.

From the results it was concluded that, in adults, diabetes results in a modest reduction in life expectancy and a substantial reduction in disability-free life expectancy. Efforts to identify the specific causes of disability and effective interventions are needed.

Practice Pearls:

  • Researchers found that risk of all diabetes-related disabilities, including severe disabilities, increased with age.
  • The authors further found that women with diabetes spent more years, both in absolute terms and in terms of proportion of their lives, with a disability compared with men with diabetes and to women without diabetes.
  • If diabetes were to be eliminated in those patients, they would gain an extra 0.6 years (95% CI 0.5-0.6) in life expectancy and 1.8 years (95% CI 1.0-2.8) in disability-free life expectancy.

Researched and prepared by Steve Freed, BPHarm, Diabetes Educator, Publisher and reviewed by Dave Joffe, BSPharm, CDE

 

Huo L, et al “Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes” Diabetologia 2016; DOI: 10.1007/s00125-016-3948-x.  Demography  August 2009, Volume 46, Issue 3, pp 627-646


Study reveals substantial reductions in years lived without disability and overall life expectancy for men and women with diabetes,” Diabetologia public release, April 14, 2016.