Objective:

To evaluate the associations of activities of daily living (ADL) and their longitudinal trajectories with the risk of diabetes-related lower-limb amputation (DLLA).

Approach:

• Study Design: Data from the Health and Retirement Study (HRS; n = 3007) and the English Longitudinal Study of Ageing (ELSA; n = 833) were analyzed using Group-Based Trajectory Modeling.
• Statistical Analysis: Cox regression models were used to evaluate associations, with competing-risk, nonlinear, subgroup, and mediation analyses performed as sensitivity and exploratory analyses.

Key Findings:

• During a median follow-up of approximately four years, 986 DLLA events occurred in the HRS cohort and 254 in the ELSA cohort.
• ADL scores were significantly associated with DLLA risk (HRS: adjusted HR = 1.10, 95% CI: 1.07–1.14; ELSA: adjusted HR = 1.20, 95% CI: 1.12–1.28).
• Higher risks of DLLA were observed in the Stable-rise (51%-84%) and Stable-high (36%-131%) ADL trajectory groups compared to the Stable-low group.
• Kaplan–Meier survival analysis showed significant differences in DLLA incidence among ADL trajectory groups (log-rank P < 0.001).
• A significant nonlinear association between ADL and DLLA risk was found, with a threshold effect around ADL ≈ 2.
• Depression partially mediated the association between ADL and DLLA risk.

Interpretation:

ADL levels and their longitudinal trajectories are significantly associated with the risk of DLLA among individuals with diabetes.

Limitations:

• The study focused specifically on DLLA as the primary outcome, limiting insights into other diabetes-related lower-limb complications.
• Existing literature primarily relies on baseline measurements of functional status, which may not capture the dynamic nature of ADL trajectories.

Conclusion:

Routine assessment of ADL may contribute to risk stratification and clinical monitoring in individuals with diabetes.