RehabWire - Volume 8, Number 10, November 2006

Diabetes

RehabWire looks at diabetes, both as a disability, and as a secondary condition to existing disabilities.

NIDRR Grantees on the Cutting Edge.

The Effects of Diabetes on the Benefits of Exercise after Stroke, Patricia M. Kluding, PT, PhD (H133F050006). A. Cate Miller, PhD, Project Officer.
Abstract: The purpose of the project is to determine whether the presence of Type II diabetes mellitus attenuates the benefits of aerobic and strengthening exercise for people with chronic stroke. The target population is 30 adults, 15 with both stroke and diabetes and 15 gender- and age-matched subjects with stroke alone. Project goals and objects include: (1) To determine whether people with stroke and diabetes have decreased baseline measures of function, cardio-respiratory fitness, muscle strength, and cognition compared to people with stroke alone; (2) to determine if people with stroke and diabetes show less improvements after a 12-week aerobic and strengthening exercise program than those with stroke alone in the areas of function, cardio-respiratory fitness, and lower extremity muscle strength; and (3) to determine if either people with stroke alone or people with stroke and diabetes show improved cognition after a 12-week aerobic and strengthening exercise program. Analysis of variants is used to examine the resulting differences in the dependent variables between subjects with stroke alone and subjects with stroke and diabetes, at baseline and after 12 weeks of exercise. The results of this study are analyzed to determine the feasibility of a large randomized clinical trial comparing the effects of a specific exercise intervention in these two groups.

Diabetes Communications for the Disabled, Med Graph, Inc. (H133S060097) led by Ed Schlueter. Edna Johnson, Project Officer.
Abstract: Med Graph, Inc. (MGI) successfully proved the feasibility of the Life Improvement Portal (LIP) Glucose Monitoring System (GMS) for persons with vision and hearing disabilities. During Phase II, MGI refines and readies the pre-production prototype for the Phase III commercialization by incorporating additional consumer input into its design, further developing the GMS capabilities to include voice output, and testing the effectiveness and consumer satisfaction levels via clinical trials. GMS works in conjunction with LIP to collect, store, analyze, and track glucose readings for people with diabetes. The GMS connects, via a standard phone line, to the LIP to ensure that the person with diabetes is immediately notified of low, normal, and high glucose thresholds that have been established by their physician. The LIP uploads glucometer information at the push of a button or at predetermined intervals throughout the day into the secure central server. Once transmitted, data is analyzed for emergency indicators, and priority information is reported back to the diabetic user via feedback from the LIP. Physicians are able to immediately access this information via the central server, helping to avoid complications from fluctuating glucose levels. All aggregated data can then be viewed by the person with diabetes, an approved caregiver, or a physician in graphical formats via a secure website that is accessible to W3C standards.
Find out more at: www.med-graph.com

Please note: These abstracts have been modified. Full, unedited abstracts, as well as any available REHABDATA citations, are available at naric.com.

Total Prevalence of Diabetes in the United States, All Ages, 2005

  • Total: 20.8 million people (7 percent of the population) have diabetes.
  • Diagnosed: 14.6 million people
  • Undiagnosed: 6.2 million people.

Source: National Diabetes Information Clearinghouse

 ADA Live, yellow letters on a black background

The American Diabetes Association (ADA) has tons of tools and resources to help people with diabetes live full, healthy lives. Visit their website at www.diabetes.org for newsletters, books, recipes, interactive tools, and a live chat.

Current Literature: Selections from REHABDATA

Gerhart, K., Weitzenkamp, D. (2000) Diabetes and spinal cord injury. PN/Paraplegia News, 54(8), 24-25. NARIC Accession Number: J40232. Project Number: H133B30040; H133G80011.
Abstract: Article with information for people with spinal cord injury (SCI) about diabetes. Topics include: diagnosis of diabetes in individuals with SCI; increased risk of diabetes due to changes in body composition and physical activity level; side effects of diabetes; management of diabetes; and the role of stress.

Bauman, W., Spungen, A. (2001) Carbohydrate and lipid metabolism in chronic spinal cord injury. Journal of Spinal Cord Medicine, 24(4), 266-277. NARIC Accession Number: J45945. Project Number: H133N000029.
Abstract: Literature review examines the prevalence of abnormalities of carbohydrate and lipid metabolism among people with spinal cord injury (SCI). Compared to the able-bodied population, people with SCI are more likely to have oral carbohydrate intolerance, insulin resistance, elevated low-density lipoprotein cholesterol, and reduced high-density lipoprotein cholesterol, which are risk factors associated with diabetes and heart disease.

McMahon, B., West, S. (2005) Workplace discrimination and diabetes: The EEOC Americans with Disabilities Act research project. Work: A Journal of Prevention, Assessment, and Rehabilitation, 25(1), 576-583. NARIC Accession Number: J49423. Project Number: H133F040034.
Abstract: Article documents the employment discrimination experiences of Americans with diabetes using data from the Equal Employment Opportunity Commission (EEOC). It presents an analysis of the allegations of employment discrimination brought under Title I of the Americans with Disabilities Act (ADA) filed by people with diabetes compared to those filed by people with other physical, sensory, and neurological impairments. Researchers examined demographic characteristics of the charging parties; the industry designation, location, and size of employers against whom complaints are filed; the nature of the discrimination allegations, and the legal outcome or resolution of the complaints. Results indicated that people with diabetes were more likely to encounter discrimination involving discharge, constructive discharge, and discipline and suspension (all job retention issues). People with diabetes were less likely to encounter discrimination involving hiring, reasonable accommodation, non-pension benefits, and layoff.

McMahon, B., West, S. (2006) Who is a person with a disability under the ADA? Mitigating circumstances, the US Supreme Court, and the case of diabetes. Journal of Vocational Rehabilitation, 24(3), 177-182. NARIC Accession Number: J51334. Project Number: H133F040034.
Abstract: Study examined the impact of the Sutton trilogy on workplace discrimination for Americans with diabetes. In 1999, three Supreme Court cases, known as the Sutton trilogy, required that mitigating circumstances be considered in determining whether or not an individual has a disability under the Americans with Disabilities Act (ADA). Mitigating measures may include medications, assistive and adaptive devices, and even internal coping mechanisms that reduce the limiting effects of impairment. The receipt, investigation, and resolution of allegations of workplace discrimination filed to the Equal Employment Opportunity Commission by Americans with diabetes before and after the Sutton decision were compared. Results indicated that the number and rate of allegations increased post-Sutton, while the number and overall proportion of non-merit resolutions decreased and the number of merit resolutions increased over the same period.

Ho, P. (2003) Determinants of health behaviors in adults with diabetes. In Changing Concepts of Health and Disability Conference Proceedings, March 17-18, 2003; Washington, DC, 62-66. NARIC Accession Number: O15044. Project Number: H133A990017.
Abstract: Study examines the personal characteristics that influence health behaviors of adults with diabetes and functional limitations. Analysis revealed that adults with diabetes-related functional limitations were more likely to use health services and engage in health risk behaviors than adults with diabetes without functional limitations. Implications for future research and policy strategies are discussed. This paper was presented at the State of the Science Conference and Policy Forum 2003.

Head, L. (Ed.). (2003) Workplace accommodations policy highlights 1.7. NARIC Accession Number: O15235. Project Number: H133E020720.
Abstract: Bimonthly newsletter reports policy, regulatory, and market factors relevant to integrating people with disabilities into the national workforce. This issue describes recent efforts by U.S. regulatory agencies such as the Equal Opportunity Commission (EEOC) and the Department of Labor (DOL) to assist employers in making accommodations for people with disabilities. The EEOC has created a fact sheet on how the Americans with Disabilities Act (ADA) applies to employment situations involving diabetes and held a meeting on the benefits of workplace mediation. The DOL designed a seminar for employers on the development, implementation, and maintenance of emergency preparedness plans for people with disabilities. Several judicial cases involving ADA violations are discussed.

Woodring, J., Foley, S. (2005) Diabetes and vocational rehabilitation employment services and outcomes. Research to Practice, 38. NARIC Accession Number: O16217. Project Number: H133A021503.
Abstract: Report presents a profile of people with diabetes who are using the vocational rehabilitation (VR) system. It compares consumers with diabetes listed as the primary cause of impairment closed in 2003 to those without diabetes listed as the primary impairment. People with diabetes tend to be older on average and have higher rates of college attendance than the general population of VR consumers. They receive vocational training, on-the-job training, job readiness training, job search service, and on-the-job supports less frequently than the non-diabetic population. The top five impairments in the diabetes population are physical or sensory in nature. People with diabetes are less likely to receive Supplemental Security Income, either at application or at closure, and more likely to receive Social Security Disability Insurance. They have higher rates of closure to homemaker of unpaid family worker status than those without diabetes.

 cropped screenshot of the website for the Harvard Center for Cancer Prevention
Are you at risk? The Harvard Center for Cancer Prevenion features a diabetes risk questionnaire at www.yourdiseaserisk.harvard.edu (along with questionnaires for stroke, heart disease, cancer, and osteoporosis).

Where Can I Find More? A quick keyword search is all you need to connect to a wealth of disability and rehabilitation research. NARIC’s databases hold more than 75,000 resources. Visit www.naric.com/research to search for literature, current and past research projects, and organizations and agencies in the US and abroad.