<b>BACKGROUND</b>: Diabetes is
linked to functional decline, but the impact of prediabetes on physical
function is unknown. We aimed to examine and compare the impact of prediabetes
and diabetes on physical function and disability progression and to explore
whether cardiovascular diseases (CVDs) mediate these associations.
<p><b>RESEARCH
DESIGN AND METHODS: </b>A cohort of 2,013 participants aged ≥60 from the Swedish National Study on Aging and Care
in Kungsholmen, an ongoing population-based longitudinal study, was followed
for up to 12 years. Physical function was measured with chair stand (s) and walking
speed (m/s) tests, and disability was measured by summing the numbers of
impaired basic and instrumental activities of daily living. Diabetes was
identified through medical examinations or clinical records, medication use, or
glycated hemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7–6.4% in
diabetes-free participants. CVDs were ascertained through clinical examinations
and the National Patient Registry. Data were analyzed using mixed effect models
and mediation models.</p>
<p><b>RESULTS: </b>At baseline,
650 (32.3%) had prediabetes and 151 had diabetes<b> </b>(7.5%).<b> </b>In
multi-adjusted mixed effect models,<b> </b>prediabetes
was associated with an increased chair stand time (0.33, 95% CI 0.05
to 0.61), a
decreased walking speed (-0.006, -0.010 to -0.002), and an
accelerated disability progression (0.05, 95% CI 0.01 to 0.08), even after
controlling for the future development of diabetes. Diabetes led to faster
functional decline than prediabetes. In mediation
analyses, CVDs mediated 7.1%, 7.8%, and 20.9% of the associations between prediabetes
and chair stand, walking speed, and disability progression, respectively. </p>
<p><b>CONCLUSIONS: </b>Prediabetes, in addition to diabetes, is associated with faster
functional decline and disability, independent of the future development of
diabetes. This association may be in part mediated by CVDs.</p>