Late-life disability following the action for health in diabetes (Look AHEAD) trial

Obesity increases risks for mobility limitations and disability in older adults. We examined the long-term effects of an intensive lifestyle intervention (ILI) versus diabetes support and education (DSE) and body mass index (BMI) on disability.

Disability was assessed using the Pepper Assessment Tool for Disability (PAT-D) over four post-trial visits in Look AHEAD participants with type 2 diabetes and overweight/obesity. Disability and severe disability were defined as self-reporting "a lot of difficulty" or "unable" to perform ≥1 and ≥3 activities, respectively, on PAT-D subscales for mobility, instrumental, and basic activities of daily living (IADLs and BADLs). Associations between intervention group and BMI with disability prevalence were analyzed with GEE regression models, adjusting for demographics, multimorbidity index, cognition, physical performance, and diabetes control.

Among 1191 participants at the first post-trial visit, mean (±SD) age was 68.7 ± 5.7 years, BMI was 34.4 ± 6.1 kg/m2; 61% were female, 69% White, and 52% assigned to ILI. Over nine years of follow-up, odds of severe mobility disability were higher for ILI participants aged ≥70 years (OR [95% CI]: 1.50 [1.02-2.20]) but lower for those in ILI <70 years (0.69 [0.48-0.99]) compared to controls (interaction p = .0043). Participants with BMI ≥35 kg/m2 had higher odds of mobility disability (2.06 [1.57-2.70]), severe mobility disability (2.52 [1.79-3.56]), and IADL disability (OR [95% CI]: 2.15 [1.53-3.02]) compared to those with BMI <30 kg/m2.

ILI was associated with greater severe mobility disability in participants ≥70. Regardless of age, those with higher BMI had increased late-life mobility and IADL disability.