Associations of activities of daily living and their trajectories with the risk of diabetes-related lower-limb amputation: evidence from the HRS and ELSA longitudinal cohorts - Scorecard - MDSpire

Associations of activities of daily living and their trajectories with the risk of diabetes-related lower-limb amputation: evidence from the HRS and ELSA longitudinal cohorts

  • By

  • Hui Guo

  • Zunwang Li

  • Yunhui Zhang

  • Ruizheng Zhu

  • Zhihong Fu

  • Dongxiao Li

  • Junde Wu

  • Zhaojun Chen

  • July 15, 2026

Share

Clinical Scorecard: Links Between Daily Living Activities and Their Progression with the Risk of Diabetes-Related Lower-Limb Amputation: Insights from HRS and ELSA Longitudinal Studies

At a Glance

CategoryDetail
ConditionDiabetes-related lower-limb amputation (DLLA)
Key MechanismsActivities of daily living (ADL) impairment, depression, peripheral neuropathy, peripheral arterial disease, microvascular injury, diabetes-related sarcopenia
Target PopulationIndividuals with diabetes, particularly older adults
Care SettingGeriatric and chronic disease epidemiology

Key Highlights

  • ADL scores significantly associated with DLLA risk (HRS: adjusted HR = 1.10; ELSA: adjusted HR = 1.20)
  • Higher DLLA risk in Stable-rise and Stable-high ADL trajectory groups
  • Significant differences in DLLA incidence among ADL trajectory groups (log-rank P < 0.001)
  • Nonlinear association between ADL and DLLA risk with a threshold effect around ADL ≈ 2
  • Depression partially mediates the association between ADL and DLLA risk

Guideline-Based Recommendations

Diagnosis

  • Assess ADL levels to identify individuals at risk for DLLA

Management

  • Implement routine assessment of ADL for risk stratification in diabetes management

Monitoring & Follow-up

  • Monitor changes in ADL trajectories to identify individuals at elevated risk of DLLA

Risks

  • Individuals with persistently poor or declining ADL function are at higher risk for DLLA

Patient & Prescribing Data

Older adults with diabetes

Dynamic changes in functional status may indicate increased risk for DLLA

Clinical Best Practices

  • Utilize group-based trajectory modeling to assess ADL changes over time
  • Incorporate mental health evaluations, such as depression screening, in ADL assessments

Related Resources & Content

Original Source(s)

Associations of activities of daily living and their trajectories with the risk of diabetes-related lower-limb amputation: evidence from the HRS and ELSA longitudinal cohorts

  • by Hui Guo, Zunwang Li, Yunhui Zhang, Ruizheng Zhu, Zhihong Fu, Dongxiao Li, Junde Wu, Zhaojun Chen

  • July 15, 2026

Related Content

Relationship between hemoglobin glycation index and mild cognitive impairment risk in middle-aged and elderly people: a cohort study from CHARLS 2011–2018

Are GLP-1s Linked to Optic Neuropathy?

A nationwide Swedish cohort found a higher relative risk of anterior ischemic optic neuropathy among GLP-1 receptor agonist users, but the overall risks were low.

Menstrual Fluid May Aid in Endometriosis Detection

Single-nucleus sequencing of menstrual fluid identified epithelial gene signatures and prioritized five candidate biomarkers that warrant validation in larger studies.