Older adults with well-controlled diabetes have less loss of mobility.

The study was conducted with 3,202 the elderly It has been shown that adequate control of blood glucose, in Diabeticsable to mitigate the decline in walking speed. Slowness in older adults is an important indicator of mobility and is associated with loss of independence and increased risk of falls, hospitalization, institutionalization and death.

The study results suggest that poor glycemic control, not diabetes itself, is the factor that characterizes decreased walking speed in older adults, regardless of previous mobility conditions, and could serve as an early screening tool for the risk of decreased walking speed in the elderly population.

“It was already known that diabetes has a negative effect on walking speed in older adults. But what we didn’t know, and the results of the study surprised us a lot, was how much adequate glycemic control could reduce this process. In comparison, older adults with diabetes [controlado ou não] They had a greater decline in walking speed than those who did not have the disease. However, this decline was much lower in individuals with adequate blood sugar control. This is another warning about the importance of controlling blood sugar levels, Thiago da Silva Alexandre, a professor in the department of gerontology at the University of Fabisp, told AFP. Federal University of São Carlos (UFSCar) And the study advisor who funded it Vesp.

It is worth noting that, in general, glycemic control is assessed by glycated hemoglobin (HbA1c) levels in the blood – a parameter that reflects the amount of circulating sugar. In individuals with diabetes, the target blood sugar level is reached when HbA1c levels are between 6.5% and 7.0%, which characterizes adequate glycemic control. HbA1c levels above 7.0% correspond to poorer glycemic control.

Work published in Journal of Diabetes, Obesity and Metabolismis the first to compare the progression of deceleration in older adults with diabetes with and without adequate glycemic control.

To this end, an analysis was carried out of a database of 3,200 British people aged over 60 who were followed for eight years within the scope of the ELSA project (English Longitudinal Study of Ageing). This longitudinal study, conducted by researchers at University College London (UK), collects multidisciplinary data from a representative sample of the British population. The analysis of the data on diabetes and slowness was carried out by the UFSCar group.

The annual decrease in walking speed in participants with diabetes and poor glycemic control was 0.015 meters per second. [m/s] “Annually, with a total decrease of 0.160 m/s over eight years. Given that the walking speed of an elderly person should be greater than 0.8 m/s, the observed decrease was one fifth of the value considered normal. In participants with diabetes and adequate glycemic control, there was also an annual decrease in walking speed, but it was 0.011 m/s per year, with a total decrease of 0.130 m/s over eight years,” says Marianne Márquez-Luiz, who led the research during her doctoral studies at UFSCar.

job loss

Researchers explain that decreased walking speed is the end product of the entire process involving high glucose levels and causing visual, neurological and muscular damage.

Diabetes is a disease that affects different organs in the body, such as the kidneys, eyes, blood vessels, muscles, and nerves. “Since a person with diabetes does not produce or produces less insulin—the hormone responsible for putting glucose into cells—this glucose builds up in the bloodstream, causing problems in the blood vessels. It binds to the walls of blood vessels, generates oxidation and increases the formation of clots and thromboses, but above all, it damages blood vessels.“Alexander details.

The researcher explains that blood vessel damage caused by diabetes also harms the nutrition of nerves and muscles. “The process of glycation of nerves, muscles and eyes gradually affects all phases of walking. It is worth noting that to achieve balance, it is necessary, in addition to good vision, that the muscles and nerves function well to transmit sensitive information to the central nervous system and generate the motor response, but with all these losses of function, the ability to walk is impaired.”

It is important to emphasize that diabetes treatment is not just about adequate blood sugar control. “This is important because it means that glucose will not be left free in the bloodstream, causing problems. But diabetes is a more complex disease, and can cause problems with the heart and kidneys, to name a few.”

slow

In the recently published study, the researchers also assessed whether walking speed before developing diabetes could influence slowness. To do this, individuals who were already slow walkers were excluded from the analysis.

“In this second analysis, with 2,126 participants, there was a greater decline in walking speed in participants with diabetes and poor glycemic control. The decline was 0.014 m/s per year, or a total of 0.222 m/s less per year. At the end of eight years, that is, more than a quarter of the value considered normal for an elderly person,” says Louise.

“The results highlight the importance of proper blood glucose control, i.e. maintaining HbA1c levels below 7.0% in older people with diabetes. In this way, accelerated loss of walking speed is avoided,” he adds.

The article “Can poor glycemic control be a predictor of slower walking speed in older adults? Evidence from the English Longitudinal Study of Ageing” can be read at: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.15549?af=R.