Objective assessment of morbidity and disability in aged diabetic patients

We decided to study the impact of diabetes mellitus on morbidity and disability in the elderly. Three groups were studied: (1) 30 consecutively admitted diabetic in‐patients; (2) 30 contemporary non‐diabetic in‐patients; (3) a community group of 30 non‐diabetic subjects. Comprehensive surveys of subjects' clinical histories, social details, visual acuities, activity of daily living (ADL) indices and mental status scores were performed. Compared with non‐diabetic in‐patients, diabetic in‐patients had a significantly higher prevalence of neuropathy (p<0.05) and amputation (p < 0.05) and significantly lower scores for the Barthel Index (p<0.02), Nottingham Extended ADL Index (p<0.001) and MMSE (p<0.05). Three of the diabetic in‐patients were registered blind.

Compared with community controls, diabetic in‐patients had a significantly higher use of social services (p<0.05), wheelchairs (p<0.01) and hospitals in the preceding year (p<0.05). They had a significantly higher prevalence of stroke (p<0.002), neuropathy (p<0.05), foot ulceration (p<0.05) and amputation (p<0.05). They scored significantly lower on Barthel Index (p<0.001), Nottingham Extended ADL Index (p<0.001) and MMSE (p<0.001).

Two conclusions were drawn from this: (1) compared with non‐diabetic control subjects, elderly in‐patients with diabetes have a high level of disability associated with a higher prevalence of micro and macro‐vascular complications; and (2) further studies on the impact of diabetes in the community may be required to guide future health care strategies in reducing this huge social, economic and personal health burden.