The Impact of Cognitive and Physical Impairments on Functional Limitations in Middle-Aged and Older Adults With Type 1 Diabetes

OBJECTIVE: Individuals with type 1 diabetes (T1D) are living longer and developing cognitive and physical impairments. The effect of these impairments on everyday functioning remains poorly understood. We evaluated whether cognitive and physical impairments were associated with functional status in participants from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. RESEARCH DESIGN AND METHODS: Participants (n = 988) completed cognitive and physical function tests and self-reported ability to complete functional activities across five domains: activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities, lower-extremity mobility, and general physical function. RESULTS: Among the participants, 77% (mean age 60 years, diabetes duration 38 years) had neither cognitive nor physical impairments, 23% had either, and 7% had both. Depressive symptomology was reported by 12% and subjective cognitive decline by 22%. Participants with versus without both impairments were more likely to report functional limitations (87% vs. 39%, P < 0.001). Cognitive and/or physical impairments, depressive symptomatology, subjective cognitive decline, and neuropathy were associated with higher odds of functional limitations across all domains. Compared with men, women had higher odds of functional limitations, including any, IADL, leisure/social, lower-extremity mobility, and general physical. Higher hemoglobin A1c was associated with higher odds of ADL limitations. History of cardiovascular disease was marginally associated with mobility limitations. CONCLUSIONS: Among middle-aged and older adults with T1D, functional limitations were common and associated with cognitive and physical impairments, depressive symptoms, subjective cognitive decline, and neuropathy. Identifying and addressing these factors may help preserve or improve functional status in aging adults with T1D.