Cognitive performance associated with self-care activities in Mexican adults with type 2 diabetes

Impact of Cognitive Impairment on Adherence to Treatment and Self-Care in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Elderly patients with diabetes have a significantly increased prevalence of mild cognitive impairment compared with people of similar age without diabetes. Tasks related to diabetes self-management involve multiple cognitive skills and processes, such as memory, attention, planning, and calculating. Impaired cognitive function can threaten the patient's ability to perform self-monitoring. The objectives of the study were: to assess cognitive deficits and the level of self-care in elderly patients with diabetes, to identify correlations between cognitive deficits and self-care, and to determine which variables influence self-care behaviors and cognitive deficits.

METHODS

The study involved 169 patients with type 2 DM. Standardized tools were used: Mini-mental State Examination (MMSE) to assess cognitive function and the Self-Care of Diabetes Inventory (SCODI) to assess the level of self-care. Socioclinical data were taken from the hospital records.

RESULTS

56.8% of patients had cognitive impairment (MMSE≤26). In the comparative analysis, patients with cognitive impairment had significantly lower results in all domains of the SCODI: self-care maintenance (72.9 vs 75), self-care monitoring (53.1 vs 56.3), self-care management (71.9 vs 84.4), self-care confidence (79.5 vs 86.4). Correlation analysis showed that the MMSE score correlates significantly and positively (p˂0.05; r˃0) with all SCODI subscales, and the higher the MMSE score the higher the level of self-care (A: r=0.252, B: r=0.244, C: r=0.019, D: r=0.28).

CONCLUSION

In this elderly type 2 diabetes population, and using only one test to verify the cognitive function, self-care management was worse in terms of self-care management (blood glucose control). Cognitive function components are independent determinants of self-care in patients with type 2 diabetes. Recall is an independent predictor of self-care maintenance, and writing a predictor of self-care monitoring.

Relationship Between Self-Care Behavior and Cognitive Function in Hospitalized Adult Patients with Type 2 Diabetes: A Cross-Sectional Study

PURPOSE

To investigate the relationship between diabetes self-care behavior and cognitive function of hospitalized young and middle-aged Chinese patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

In this cross-sectional study, young and middle-aged T2DM patients (age range, 35-65 years) were recruited at 4 tertiary hospitals between July 2016 and January 2017. Data pertaining to self-care behavior and cognitive function were collected using two questionnaires (the Summary of Diabetes Self-care Activities [SDSCA] and the Montreal Cognitive Assessment [MoCA], respectively). Multivariate linear regression analysis was performed to assess the correlation between cognitive function and self-care activities.

RESULTS

A total of 140 patients with diabetes were enrolled (mean age, 53.79±7.96 years). The mean duration of T2DM was 10.83±6.76 years. Regarding SDSCA performance, the mean scores for foot care and blood glucose monitoring were 2.20±2.57 and 1.98±2.45, respectively, which were the worst; scores for exercise (4.01±2.58) and diet (3.16±1.89) were better, while scores for medication administration (5.26±2.79) were the best. The prevalence of cognitive impairment was 37.9% (53 patients). After variables adjustment, delayed recall showed a significant correlation with blood sugar monitoring behavior (B =0.224, P=0.019); visual space and executive function (B=0.255, P=0.009) and abstraction (B=-0.337, P=0.001) showed a correlation with foot care behavior.

CONCLUSION

Cognitive ability affects the self-care behavior of patients with T2DM. Assessment of cognitive function may help inform patient education interventions to improve the self-care behavior of these patients.

Perceived cognitive deficits are associated with diabetes self-management in a multiethnic sample

Background

People with diabetes have almost twice the risk of developing cognitive impairment or dementia as do those without diabetes, and about half of older adults with diabetes will become functionally disabled or cognitively impaired. But diabetes requires complex self-management: patients must learn about the implications of their disease; manage their diets, physical activity, and medication; and monitor their blood glucose. Difficulties with cognition can hinder these activities.

Methods

The purpose of this study was to explore perceptions of cognitive ability in a multiethnic sample of persons with type 2 diabetes (T2DM). One hundred twenty participants completed surveys assessing perceived memory, executive function, diabetes self-management, and quality of life. Scores on the surveys were examined along with hemoglobin A1C levels and demographics.

Results

Scores for executive function were positively associated with self-reports of dietary adherence and blood glucose monitoring. Perceived memory ability was a significant predictor of quality of life, and executive function was a significant predictor of A1C.

Conclusions

Patients’ perceptions of their cognitive difficulties may assist health care providers in detection of patients’ deficiencies in performing diabetes self-management tasks. The relationships between cognitive difficulties and self-management found in this descriptive study suggest that research on the processes leading to cognitive changes in T2DM is needed, as are studies on how those processes affect diabetes self-management.

Mild cognitive dysfunction does not affect diabetes mellitus control in minority elderly adults

OBJECTIVES

To determine whether older adults with type 2 diabetes mellitus and cognitive dysfunction have poorer metabolic control of glycosylated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol than those without cognitive dysfunction.

DESIGN

Prospective cohort study.

SETTING

A minority cohort in New York City previously recruited for a trial of telemedicine.

PARTICIPANTS

Persons aged 73.0 ± 3.0 (N = 613; 69.5% female; 82.5% Hispanic, 15.5% non-Hispanic black).

MEASUREMENTS

Participants were classified with executive or memory dysfunction based on standardized score cutoffs (<16th percentile) for the Color Trails Test and Selective Reminding Test. Linear mixed models were used to compare repeated measures of the metabolic measures and evaluate the rates of change in individuals with and without dysfunction.

RESULTS

Of the 613 participants, 331 (54%) had executive dysfunction, 202 (33%) had memory dysfunction, and 96 (16%) had both. Over a median of 2 years, participants with executive or memory dysfunction did not exhibit significantly poorer metabolic control than those without executive function or memory type cognitive dysfunction.

CONCLUSION

Cognitive dysfunction in the mild range did not seem to affect diabetes mellitus control parameters in this multiethnic cohort of older adults with diabetes mellitus, although it cannot be excluded that cognitive impairment was overcome through assistance from formal or informal caregivers. It is possible that more-severe cognitive dysfunction could affect control.

Factors associated with cognitive decline in elderly diabetics

BACKGROUND/AIMS

Although recent evidence has indicated that type 2 diabetes mellitus (T2DM) in the elderly is a risk factor for cognitive dysfunction or dementia, few studies have prospectively observed this potential cognitive decline. In the current study, we performed cognitive assessments at baseline and after 3 years in the same patient group in an attempt to reveal the contributions of diabetes-related factors to the increased decline in cognitive function in elderly patients with T2DM.

METHODS

We recruited 55 consecutive T2DM patients with a Mini-Mental State Examination (MMSE) score ≥24 from the Diabetic Center at the Chubu Rosai Hospital. These patients ranged in age from 65 to 85 years. Cognitive and clinical assessments, including brain MRI, were performed at baseline and at the 3-year follow-up.

RESULTS

The higher plasma insulin and HbA(1c) levels observed at baseline were significantly associated with a worse cognitive performance at baseline and a more neurocognitive decline at the follow-up visit.

CONCLUSION

The current prospective study suggests that higher insulin and glycohemoglobin levels may be associated with diabetes-related cognitive dysfunction.