What is it about?
This 6-year study of 843 older adults with diabetes tested whether simple functional categories—based on cognition (MMSE), instrumental ADL (TMIG-IC), basic ADL (Barthel Index), and multimorbidity—predict all-cause mortality. Patients were grouped into Category I (intact), Category II (mild cognitive/IADL impairment), and Category III (moderate–severe cognitive or BADL impairment, or ≥4 comorbidities). Across three models (including a brief DAFS-8 version), higher category = higher death risk, even after adjusting for age, sex, BMI, HbA1c, BP, cholesterol, eGFR, and severe hypoglycemia.
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Why is it important?
Clear, graded risk: Compared with Category I, Category II ≈ 1.8× and Category III ≈ 3× higher adjusted mortality risk. Works with simple tools: The pattern held using both full scales (MMSE, TMIG-IC, BI) and the shortened DAFS-8. Multimorbidity matters most: Having ≥4 comorbidities carried the highest risk, supporting its inclusion in targets. Treatment sensitivity: The category–mortality link was strongest in insulin or sulfonylurea users, underscoring hypoglycemia vulnerability. Age nuance: In adults ≥75 years, Category III risk was high; Categories I and II were more similar—aligning with gentler targets in the oldest old.
Perspectives
Set glycemic targets by function, not HbA1c alone: Use Category I–III to individualize goals and avoid both hyper- and hypoglycemia. Screen fast, act early: Brief tools (e.g., DAFS-8) can flag Category II—triggering multimodal interventions (exercise, nutrition, social support, med review). Prioritize hypoglycemia prevention: Especially in insulin/SU users—simplify regimens, de-intensify when appropriate, educate for sick-day and hypo management. Manage multimorbidity proactively: Coordinate care for cardiovascular, neurologic, renal, and depressive comorbidities that compound risk. Research next steps: Test whether improving category status (via exercise, nutrition, social participation, and optimized therapy) improves survival.
Prof Takuya Omura
National Center for Geriatrics and Gerontology
Read the Original
This page is a summary of: Functional categories based on cognition and activities of daily living predict all‐cause mortality in older adults with diabetes mellitus: The Japanese Elderly Diabetes Intervention Trial, Geriatrics and Gerontology International, April 2021, Wiley,
DOI: 10.1111/ggi.14171.
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