The Relationship Between Pathoglycemia And Poor Physical Performance In Elderly People Of Tianjin

Objective:The objective of this study is 1) to determine whether a relationship exists between performance-based physical assessments and pre-diabetes/diabetes in an older Chinese population, and analyzing whether pathoglycemia have an bad effect on physical performance; 2) to analyze the characteristic of subjects who with glycemic deterioration, and trying to find out which factors can accelerate the rate of glycemic deterioration. Methods:Our study population comprised 976 subjects(mean ± SD age: 67.6 ± 6.0 years; 44.5% men) from the Hangu area of Tianjin during March-April, 2013. All subjects were invited to participate in some objective examinations and questionnaires and asked to do the same objective examinations and questionnaires again next year. Objective examinations including physical performance-based assessments(grip, TUGT and 4-m walk tests), blood examination and anthropometry(height, weight and BMI). Age, occupation, educational level, history of physical illness, information on smoking and drinking, daily physical activity(IPAQ) and fall history were also assessed by questionnaire. Diabetes was defined by self-reporting of a physician’s diagnosis, or a fasting plasma glucose level ≥7.0mmol/l; and pre-diabetes was defined as a fasting plasma glucose level ≥5.6 mmol/l and <7.0 mmol/l; and Euglycemia was defined as a fasting plasma glucose level <5.6 mmol/l. Results:1. When age, BMI, blood biochemical indices, occupation, education level, history of diseases, history of smoking and drinking habits, physical activity(IPAQ) and history of falls were adjusted for, men needing longer to finish TUGT and a decreased usual walking speed had higher odds of pre-diabetes(P for trend= 0.007 and 0.004, respectively), but there were no statistically significant of this difference in women. On the other hand, no matter men and women, subjects needing longer to finish TUGT and a decreased usual walking speed had a higher odds of diabetes(TUGT: men P for trend= 0.012, women P for trend= 0.020; usual walking speed: men P for trend= 0.014, women P for trend=0.034). At last, after adjusting all other variables, men needing longer to finish TUGT and a decreased usual walking speed had higher odds of pathoglycemia(pre-diabetes+diabetes)(P for trend= 0.014 and 0.017, respectively), but there were no statistically significant of this difference in women. There was no apparent association between grip strength and pre-diabetes/diabetes in both sexes.2. The changes of physical performance after one year in subject with pathoglycemia: There were no statistically differences of the changes of grip, TUGT and usual walking speed between pre-diabetes/diabetes and normoglycemia.3. The characteristic of subjects with glycemic deterioration: Subjects with glycemic deterioration(n=9) were more likely than subject with glycemic improvement(n=58) in pre-diabetes with lower grip strength(P =0.025) and usual walking speed(P =0.040), and to have a higher level of FPG(P =0.035). On the other hand, subjects with glycemic deterioration(n=29) in normoglycemia were more likely with higher BMI(P =0.035) and rate of never drinking(P =0.035) than normoglycemia(n=449). Conclusions:In this study, poor lower extremity function was not only associated with diabetes, but also with pre-diabetes in older people, especially for men. And some effective physical performance-based test of lower extremity function can help us to forecast physical dysfunction and start rehabilitation therapy early. In addition, maybe it’s a better way for prevention of glycemic deterioration if glycemic control and exercise prescription can be implemented at the same time.