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Motamed-Jahromi M, Kaveh MH, Vitale E. Mindfulness and self-regulation intervention for improved self-neglect and self-regulation in diabetic older adults. Sci Rep 2024; 14:13857. [PMID: 38879620 PMCID: PMC11180124 DOI: 10.1038/s41598-024-64314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/07/2024] [Indexed: 06/19/2024] Open
Abstract
The current study aimed to assess the impact of combined interventions including mindfulness and self-regulation on self-neglect and self-regulation among Iranian older adults with type 2 diabetes. This was a three-arm cluster randomized controlled trial study conducted among 135 older diabetic patients in Shiraz, Iran. Three urban healthcare centers (clusters) were randomly assigned to three study groups. The intervention groups received either a Self-Regulation-based Intervention Program (SRIP) or a Combined Mindfulness and Self-Regulation Intervention Program (CMSRIP), while the control group received routine care and COVID-19 prevention training. These training programs, which consisted of text and video-based content, were conducted over 24 weeks using WhatsApp as a mobile-based communication platform. Outcomes were measured using the Elder Self-Neglect Scale and Short-Form Self-Regulation Questionnaire at baseline, week 4, and week 16 post-intervention, with data analysis conducted using SPSS 20 software. The CMSRIP led to significantly greater improvement in the score of self-regulation (χ2 = 73.23, P-Value = < .001) and a reduction in the score of self-neglect (χ2 = 62.97, P-Value = < .001) at both 4 weeks and 16 weeks after education compared to SRIP. In the control group, there was also a slight improvement. Improvement of self-regulation and reduction of self-neglect in all three groups were less in week 16 than in week 4. Nevertheless, the changes in the intervention groups were significantly better than the control group. This study confirmed a combination of mindfulness-based intervention and self-regulation intervention can effectively improve self-neglect and self-regulation behavior in older patients with type 2 diabetes.Trial registration: This trial (ISRCTN77260130) was retrospectively registered on 28/09/2021.
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Affiliation(s)
| | - Mohammad Hossein Kaveh
- Research Center for Health Sciences, Department of Health Promotion, School of Health, Institute of Health, Shiraz University of Medical Sciences, Razi Boulevard, P.O. Box: 7153675541, Shiraz, Iran.
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Pujol A, Sanchis P, Tamayo MI, Nicolau J, Grases F, Espino A, Estremera A, Rigo E, Amengual GJ, Rodríguez M, Ribes JL, Gomila I, Simó-Servat O, Masmiquel L. Oral phytate supplementation on the progression of mild cognitive impairment, brain iron deposition and diabetic retinopathy in patients with type 2 diabetes: a concept paper for a randomized double blind placebo controlled trial (the PHYND trial). Front Endocrinol (Lausanne) 2024; 15:1332237. [PMID: 38872972 PMCID: PMC11169791 DOI: 10.3389/fendo.2024.1332237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Type 2 diabetes mellitus has a worldwide prevalence of 10.5% in the adult population (20-79 years), and by 2045, the prevalence is expected to keep rising to one in eight adults living with diabetes. Mild cognitive impairment has a global prevalence of 19.7% in adults aged 50 years. Both conditions have shown a concerning increase in prevalence rates over the past 10 years, highlighting a growing public health challenge. Future forecasts indicate that the prevalence of dementia (no estimations done for individuals with mild cognitive impairment) is expected to nearly triple by 2050. Type 2 diabetes mellitus is a risk factor for the development of cognitive impairment, and such impairment increase the likelihood of poor glycemic/metabolic control. High phytate intake has been shown to be a protective factor against the development of cognitive impairment in observational studies. Diary phytate intake might reduce the micro- and macrovascular complications of patients with type 2 diabetes mellitus through different mechanisms. We describe the protocol of the first trial (the PHYND trial) that evaluate the effect of daily phytate supplementation over 56 weeks with a two-arm double-blind placebo-controlled study on the progression of mild cognitive impairment, cerebral iron deposition, and retinal involvement in patients with type 2 diabetes mellitus. Our hypothesis proposes that phytate, by inhibiting advanced glycation end product formation and chelating transition metals, will improve cognitive function and attenuate the progression from Mild Cognitive Impairment to dementia in individuals with type 2 diabetes mellitus and mild cognitive impairment. Additionally, we predict that phytate will reduce iron accumulation in the central nervous system, mitigate neurodegenerative changes in both the central nervous system and retina, and induce alterations in biochemical markers associated with neurodegeneration.
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Affiliation(s)
- Antelm Pujol
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Pilar Sanchis
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Laboratory of Renal Lithiasis Research, University of Balearic Islands, Research Institute of Health Science (IUNICS) Health Research Institute of Balearic Islands, (IdISBa), Palma de Mallorca, Spain
| | - María I. Tamayo
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Joana Nicolau
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University of Balearic Islands, Research Institute of Health Science (IUNICS) Health Research Institute of Balearic Islands, (IdISBa), Palma de Mallorca, Spain
| | - Ana Espino
- Neurology Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Ana Estremera
- Neuroradiology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Elena Rigo
- Neuroopthalmology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | | | - Manuel Rodríguez
- Neuroradiology Unit, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - José L. Ribes
- Biochemistry Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Isabel Gomila
- Biochemistry Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Masmiquel
- Vascular and Metabolic Diseases Research Group, Endocrinology Department, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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Wada A, Kabayama M, Godai K, Kido M, Ohata Y, Murakami N, Nakamura Y, Yoshida H, Hashimoto S, Higashi M, Hatanaka H, Kikuchi T, Terauchi K, Nagayoshi S, Matsuno F, Shinomiya N, Asayama K, Ohkubo T, Rakugi H, Tabara Y, Kamide K. Factors influencing the continuation of home blood pressure measurement in community-dwelling older adults: the NOSE study. J Hypertens 2024; 42:694-700. [PMID: 38088418 PMCID: PMC10906215 DOI: 10.1097/hjh.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE This study aimed to identify the factors influencing home blood pressure measurement (HBPM) continuation in community-dwelling older adults. METHODS A longitudinal analysis used the NOSE study intervention group datasets. The participants were encouraged HBPM with self-monitoring devices provided to them twice in the morning and twice in the evening. Every 7-day interval from the HBPM start date was defined as 1 week, and the number of HBPMs per week was counted. The first week in which the number of HBPMs was zero was defined as the week in which HBPM was discontinued. Participants who did not experienced discontinuation until the end of the observation period were considered complete survivors in the survival time analysis. RESULTS Data from 437 participants were included in the analysis. Of these, 120 (27.5%) discontinued HBPM. In univariate analysis, factors significantly associated with HBPM discontinuation included exercise habits [hazard ratio per one unit 0.47; 95% confidence interval (CI) 0.31-0.69], social participation (hazard ratio 0.65; 95% CI 0.42-0.99), MoCA-J score (hazard ratio 0.94; 95% CI 0.90-0.98), and frailty (hazard ratio 5.20; 95% CI 2.87-9.43). In multivariate analysis, factors significantly associated with HBPM discontinuation included sex (hazard ratio 0.55; 95% CI 0.32-0.95; ref. = female individuals), smoking history (hazard ratio 1.69; 95% CI 1.02-2.80), exercise habits (hazard ratio 0.51; 95% CI 0.30-0.85), MoCA-J score (hazard ratio 0.93; 95% CI 0.88-0.98), and frailty (hazard ratio 3.31; 95% CI 1.50-7.29). CONCLUSION Among community-dwelling older adults, female sex, smoking history, lack of exercise, cognitive decline, and frailty were identified as factors influencing HBPM discontinuation.
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Affiliation(s)
- Arisa Wada
- Division of Health Sciences, Osaka University Graduate School of Medicine
- Nose Town, Osaka
| | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Kayo Godai
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Michiko Kido
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Yuka Ohata
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Naoko Murakami
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Yuko Nakamura
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroko Yoshida
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | - Kei Asayama
- Department of Hygiene and Public Health Teikyo University School of Medicine, Tokyo
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health Teikyo University School of Medicine, Tokyo
| | - Hiromi Rakugi
- Division of Health Sciences, Osaka University Graduate School of Medicine
- Osaka Rosai Hospital, Osaka
| | - Yasuharu Tabara
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-Ku, Shizuoka, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University Graduate School of Medicine
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Sola T, Sola FM, Jehkonen M. The Effects of Type 2 Diabetes on Cognitive Performance: A Review of Reviews. Int J Behav Med 2024:10.1007/s12529-024-10274-6. [PMID: 38467963 DOI: 10.1007/s12529-024-10274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Multiple systematic reviews have found that type 2 diabetes is associated with cognitive decrements. However, these reviews are heterogeneous in terms of methodology, quality and results, making it difficult for researchers and clinicians to build an informed overall picture. We therefore conducted a review of systematic reviews on the association between type 2 diabetes and cognitive decrements in relation to healthy controls. METHODS Following a pre-registered research protocol, we searched four major databases. Nine systematic reviews met our inclusion criteria: seven were meta-analyses and two were narrative syntheses. We assessed the risk of bias in each review and reported all effect sizes and confidence intervals obtained. RESULTS Type 2 diabetes was associated with cognitive decrements in all reviews, with small or negligible effect sizes obtained in the largest meta-analyses. The most studied cognitive domains were attention, executive functions, memory, processing speed and working memory. All reviews had methodological issues and were rated as having a high or an unclear risk of bias. CONCLUSIONS Type 2 diabetes appears to be associated with lower cognitive performance in several cognitive domains and in different age groups. However, high-quality meta-analyses on the subject are still needed. Future reviews must follow the PRISMA guidelines and take into account the risk of bias of the original studies through sensitivity analyses and the heterogeneity of the studies by conducting subgroup analyses for example according to age group and disease duration. The meta-analyses that aim to study the entire type 2 diabetes population without excluding severe comorbidities, should assess concept formation and reasoning, construction and motor performance, perception, and verbal functions and language skills in addition to the cognitive domains that have been most frequently analysed in the reviews conducted so far.
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Affiliation(s)
- Teppo Sola
- Psychology, Tampere University, Tampere, Finland.
- Tampere University Hospital, Tampere, Finland.
| | | | - Mervi Jehkonen
- Psychology, Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
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5
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Guo L, Xiao X. Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). Aging Med (Milton) 2024; 7:5-51. [PMID: 38571669 PMCID: PMC10985780 DOI: 10.1002/agm2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
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Affiliation(s)
- Lixin Guo
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xinhua Xiao
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of EndocrinologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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Todd S, Reagan L, Laguerre R. Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development. JOURNAL OF FORENSIC NURSING 2023; 19:262-270. [PMID: 35482339 DOI: 10.1097/jfn.0000000000000396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the relationships of health literacy (HL; Short Test of Functional Health Literacy), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated persons transitioning to the community. METHODS Using preintervention data from a quasi-experimental nonequivalent control group study evaluating the feasibility of a six-session literacy-tailored Diabetes Survival Skills intervention for incarcerated men transitioning to the community, we conducted correlational analyses among the Short Test of Functional Health Literacy, Montreal Cognitive Assessment, and Spoken Knowledge in Low Literacy in Diabetes Scale using the SPSS PROCESS macro and bias-corrected bootstrapping to test the meditational hypothesis: HL mediates the relationship between CI and DK. RESULTS Participants ( N = 73) were incarcerated for 1-30 years with a mean age of 47 (9.9) years, 40% Black, 19% White, and 30% Hispanic, with 78% having high school/GED or less education. Most (70%) screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL ( b = 0.866, p = 0.0003) but not on DK ( b = 0.119, p = 0.076). Results indicated a significant indirect effect of cognitive functioning on DK via HL, 95% confidence interval [0.300, 0.1882]. CONCLUSION Intervention approaches aimed at increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK in this population. IMPLICATIONS Given the low risk to high benefit of implementing literacy-tailored approaches to persons in prison and the population demographics from studies supporting a high degree of CI, nurses should consider implementing literacy-tailored approaches and screening for CI before participation in all educational programs.
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Affiliation(s)
| | | | - Rick Laguerre
- Department of Psychological Sciences, University of Connecticut
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Boguszewski CL, Korbonits M, Artignan A, García AM, Houchard A, Ribeiro-Oliveira A, de Herder WW. Evaluating home injection compared with healthcare-setting injection of somatostatin analogs: a systematic literature review. Endocrine 2023; 79:527-536. [PMID: 36369434 PMCID: PMC9651885 DOI: 10.1007/s12020-022-03227-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE A systematic literature review was conducted to assess the use of home injections (self/partner/healthcare provider [HCP]-administered) of somatostatin analogs (SSAs) as an alternative to healthcare-setting injections in patients with acromegaly and neuroendocrine tumors (NETs). METHODS MEDLINE/Embase/the Cochrane Library (2001-September 2021), key congresses (2019-2021), and bibliographies of relevant systematic reviews were searched. Eligible studies reported on efficacy/effectiveness, safety, adherence, patient-reported outcomes (PROs), and economic outcomes in populations receiving home injections of SSAs. RESULTS Overall, 12 studies were included, all reporting on SSAs (lanreotide Autogel/Depot or octreotide long-acting release) in acromegaly or NETs. Across four studies, home injection was associated with similar disease control in patients with acromegaly/NETs compared with healthcare-setting administration. High rates of treatment adherence were shown in two studies of patients with acromegaly receiving lanreotide injections at home. Two studies reported non-serious adverse events; incidence of adverse reactions was similar in both the home and healthcare administration settings. Preference for injection setting varied between studies and indications; nonetheless, higher satisfaction/convenience (>75% patients) was reported for home injections. Self- or partner-injection was associated with economic savings compared with administration in the healthcare setting across five studies. CONCLUSION Efficacy/effectiveness, adherence, and safety outcomes of SSAs in the home injection setting were similar to those in the healthcare setting, with high reported satisfaction and convenience. Self/partner injection also resulted in cost savings. These findings provide a basis to understand outcomes related to home injection and encourage healthcare providers to discuss optimal treatment choices with their patients.
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Affiliation(s)
- Cesar L Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.
| | - Márta Korbonits
- Department of Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | - Wouter W de Herder
- Sector of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
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8
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Kowall B, Rathmann W. Combined Effects of Diabetes and Education on Decline of Cognitive Performance in the Older Population: The Survey of Health, Ageing, and Retirement in Europe. Gerontology 2023; 69:172-180. [PMID: 35569442 DOI: 10.1159/000524571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS Diabetes management requires cognitive abilities. Unfortunately, diabetes is a risk factor for cognitive decline. However, the effects of diabetes in persons with reduced cognitive reserves are unclear. We aimed to examine whether the effects of diabetes and education on cognitive skills simply add up or deviate from simple additivity. METHODS We used data from waves 1 to 7 (except wave 3) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) collected between 2004 and 2017. SHARE includes 140,000 persons aged ≥50 years from 28 European countries and Israel. Diabetes was assessed by self-report and education was coded according to the International Standard Classification of Education levels. Verbal fluency, immediate, and delayed memory were assessed using standard tests. Interaction between diabetes and education was estimated from interaction contrasts and from interaction terms in adjusted regression models. RESULTS At baseline, cognitive performance declined in the order "no diabetes/high education" > "diabetes/high education" > "no diabetes/low education" > "diabetes/low education" for all three tests - e.g., the first group named 21.4 ± 7.2, the fourth group 14.6 ± 6.1 animals in a minute in the test of verbal fluency. Interaction contrasts and regression coefficients of interaction terms were close to zero, showing that the effects of diabetes and education on cognitive performance added up without interaction both in cross-sectional and longitudinal analyses. CONCLUSION We have observed no interaction between education and diabetes on cognitive skills. Yet, people with diabetes and low education showed poor cognitive performance and should receive particular support in managing diabetes.
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Affiliation(s)
- Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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9
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Ko D, Dietrich MS, Gifford KA, Ridner SH. Subjective Cognition Reported by Caregivers Is Correlated With Objective Cognition in Liver Transplant Recipients. Liver Transpl 2022; 28:269-279. [PMID: 34137503 PMCID: PMC8785255 DOI: 10.1002/lt.26213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
Objective cognitive assessments, a gold standard diagnostic tool for cognitive impairment, may not be feasible in busy liver transplantation (LT) practice because they are often time consuming. This study determined whether subjective cognition, patients' self-ratings and/or caregivers' ratings of patients' cognition, reflects objective cognition in LT recipients. A convenience sample of 60 adult LT recipients and their caregivers, recruited at a single transplant center, participated in this cross-sectional descriptive study. Subjective cognition (ie, recipient self-rated and caregiver rated) was measured using the Everyday Cognition (ECog; global and 6 domain scores). Objective global and domain-specific cognition of recipients was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test parts A and B, Digit Span Backward, and Rey-Osterrieth Complex Figure. Agreement between LT recipients' ECog scores and those of their caregivers was fair to moderate (intraclass correlation coefficient = 0.48 for global score, 0.35-0.56 for domain scores). Significant, albeit rather weak, correlations were found between subjective and objective scores. Recipients' ECog visuospatial abilities scores were correlated with Rey-Osterrieth Complex Figure scores (rs = -0.39; P = 0.007), whereas caregivers' ECog global, attention, visuospatial abilities, and organization scores were, respectively, correlated with the scores of RBANS global (rs = -0.33; P = 0.04) and attention (rs = -0.46; P = 0.005), Rey-Osterrieth Complex Figure (Copy; rs = -0.34; P = 0.03), and Trail Making Test part A (rs = 0.31; P = 0.049). The findings suggest that caregivers may estimate LT recipients' cognition better than recipients themselves. Caregivers may provide supplemental information that could be useful for clinicians when considering the cognitive functioning of LT recipients.
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Affiliation(s)
- Dami Ko
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee,Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine A. Gifford
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sheila H. Ridner
- School of Nursing, Vanderbilt University, Nashville, Tennessee,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Laursen DH, Rom G, Banghøj AM, Tarnow L, Schou L. Improving Diabetes Self-management by Providing Continuous Positive Airway Pressure Treatment to Patients With Obstructive Sleep Apnea and Type 2 Diabetes: Qualitative Exploratory Interview Study. JMIR Form Res 2021; 5:e27062. [PMID: 34283032 PMCID: PMC8335608 DOI: 10.2196/27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/03/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) among patients with type 2 diabetes. The daytime symptoms of OSA include severe fatigue, cognitive problems, a decreased quality of life, and the reduced motivation to perform self-care. These symptoms impair the management of both diabetes and daily life. OSA may therefore have negative implications for diabetes self-management. Continuous positive airway pressure (CPAP) therapy is used to treat OSA. This treatment improves sleep quality, insulin resistance, and glycemic control. Although the benefits of using CPAP as a treatment for OSA are clear, the noncompliance rate is high, and the evidence for the perceived effect that CPAP treatment has on patients with type 2 diabetes and OSA is poor. Objective The purpose of this study was to analyze the impacts that comorbid diabetes and OSA have on the daily lives of older adults and to investigate the perceived effect that CPAP treatment for OSA has on patients’ diabetes self-management. Methods A qualitative follow-up study that involved in-depth, semistructured dyad interviews with couples before and after CPAP treatment (N=22) was conducted. Patients were recruited from the Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, aged >18 years, and had an apnea-hypopnea index of ≥15. All interviews were coded and analyzed via thematic analysis. Results The results showed that patients and their partners did not consider OSA to be a serious disorder, as they believed that OSA symptoms were similar to those of the process of aging. Patients experienced poor nocturnal sleep, took frequent daytime naps, exhibited reduced cognitive function, and had low levels of physical activity and a high-calorie diet. These factors negatively influenced their diabetes self-management. Despite the immediate benefit of CPAP treatment, most patients (11/12, 92%) faced technical challenges when using the CPAP device. Only the patients with severe OSA symptoms that affected their daily lives overcame the challenges of using the CPAP device and thereby improved their diabetes self-management. Patients with less severe symptoms rated CPAP-related challenges as more burdensome than their symptoms. Conclusions If used correctly, CPAP has the potential to significantly improve OSA, resulting in better sleep quality; improved physical activity; improved diet; and, in the end, better diabetes self-management. However, there are many barriers to undergoing CPAP treatment, and only few patients manage to overcome these barriers and comply with correct treatment.
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Affiliation(s)
| | - Gitte Rom
- Institute of Nursing, University College Copenhagen, Copenhagen, Denmark
| | | | - Lise Tarnow
- Department of Endocrinology and Nephrology, Hillerød Hospital, Hillerød, Denmark.,Steno Diabetes Center Sjælland, Holbæk, Denmark
| | - Lone Schou
- Institute of Nursing, University College Copenhagen, Copenhagen, Denmark
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11
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Kim MJ, Fritschi C. Relationships Between Cognitive Impairment and Self-Management in Older Adults With Type 2 Diabetes: An Integrative Review. Res Gerontol Nurs 2020; 14:104-112. [PMID: 33306809 DOI: 10.3928/19404921-20201117-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cognitive impairment is common in older adults with diabetes and is likely to negatively affect their daily diabetes self-management behaviors (DSMB). The primary aim of this integrative review was to summarize and synthesize the current state of knowledge about relationships between cognitive impairment and DSMB in older adults with type 2 diabetes. The review was guided by Whittemore and Knafl's 2005 framework, and study quality was evaluated using the Crowe Critical Appraisal Tool. Of 27 studies reviewed, 24 were quantitative, and three were qualitative. Heterogeneity was noted in study design, participant characteristics, and measures of cognitive function and DSMB. Overall, global cognitive impairment and executive function impairment related particularly to poor medication management and glucose self-monitoring. The findings supported the need for routine cognitive assessment of older adults with diabetes, but more longitudinal and interventional studies are needed to better define cognitive impairment-DSMB relationships. [Research in Gerontological Nursing, 14(2), 104-112.].
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Zhou J, Zhang Z, Zhou H, Qian G. Diabetic Cognitive Dysfunction: From Bench to Clinic. Curr Med Chem 2020; 27:3151-3167. [PMID: 30727866 DOI: 10.2174/1871530319666190206225635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/30/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes increases the risk of developing cognitive dysfunction in the elderly in the form of short-term memory and executive function impairment. Genetic and diet-induced models of type 2 diabetes further support this link, displaying deficits in working memory, learning, and memory performance. The risk factors for diabetic cognitive dysfunction include vascular disease, hypoglycaemia, hyperlipidaemia, adiposity, insulin resistance, lifestyle factors, and genetic factors. Using neuronal imaging technologies, diabetic patients with cognitive dysfunction show atrophy of the whole brain, particularly the grey matter, hippocampus and amygdala; increased volume of the ventricular and white matter; brain infarcts; impaired network integrity; abnormal microstructure; and reduced cerebral blood flow and amplitude of low-frequency fluctuations. The pathogenesis of type 2 diabetes with cognitive dysfunction involves hyperglycaemia, macrovascular and microvascular diseases, insulin resistance, inflammation, apoptosis, and disorders of neurotransmitters. Large clinical trials may offer further proof of biomarkers and risk factors for diabetic cognitive dysfunction. Advanced neuronal imaging technologies and novel disease animal models will assist in elucidating the precise pathogenesis and to provide better therapeutic interventions and treatment.
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Affiliation(s)
- Jiyin Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Zuo Zhang
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Hongli Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Guisheng Qian
- Institute of Respiratory Diseases, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
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Sikorskii A, Given CW, Given BA, Banik A, Krauss JC. Patient Engagement With an Automated Telephone Symptom Management Intervention: Predictors and Outcomes. Ann Behav Med 2020; 54:484-494. [PMID: 31925414 DOI: 10.1093/abm/kaz067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Self-management of symptoms related to cancer and its treatment is important for maintaining treatment regimens and improving outcomes. PURPOSE To determine factors associated with engagement in a symptom self-management intervention among patients initiating oral anticancer treatment. METHODS This secondary analysis included 127 patients randomized to the medication adherence reminder and symptom management intervention in a recently completed trial. Patients were recruited from six Comprehensive Cancer Centers, interviewed at intake, and mailed a Symptom Management Toolkit (Toolkit) with self-care management strategies for 18 symptoms. During eight automated telephone weekly calls, patients were asked to use the Toolkit to manage elevated symptoms. Toolkit use and symptoms were tracked weekly, and generalized linear mixed-effects models were used to determine factors predictive of Toolkit use. General linear modeling was used to relate the Toolkit use during intervention to postintervention symptom severity. RESULTS Better cognitive function at intake into the trial and higher symptom burden were predictive of the patients' initial decision to try the Toolkit during Week 1. In subsequent weeks, Toolkit use in the previous week and worsening of symptoms were associated with greater odds of Toolkit use. The extent of Toolkit use modified the relationship between intake and 8 week symptom severity: among patients with higher levels of severity at intake, use of the Toolkit conferred greater benefit at 8 weeks. CONCLUSIONS Patients make realistic decisions regarding when to use a self-directed approach to self-management and are likely to use strategies when their symptoms are higher and to forego use once symptoms subside. CLINICAL TRIAL REGISTRATION NCT02043184.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry and Department of Statistics and Probability, Michigan, State University, East Lansing, MI, USA
| | - Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Asish Banik
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
| | - John C Krauss
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Choi SE, Roy B, Freeby M, Mullur R, Woo MA, Kumar R. Prefrontal cortex brain damage and glycemic control in patients with type 2 diabetes. J Diabetes 2020; 12:465-473. [PMID: 31886635 PMCID: PMC7210044 DOI: 10.1111/1753-0407.13019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/25/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study examined brain tissue integrity in sites that controls cognition (prefrontal cortices; PFC) and its relationships to glycemic outcomes in adults with type 2 diabetes mellitus (T2DM). METHODS We examined 28 T2DM patients (median age 57.1 years; median body mass index [BMI] 30.6 kg/m2 ;11 males) and 47 healthy controls (median age 55.0 years; median BMI 25.8 kg/m2 ; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [HbA1c]), and PFC tissue status via brain magnetic resonance imaging (MRI). High-resolution T1-weighted images were collected using a 3.0-Tesla MRI scanner, and PFC tissue changes (tissue density) were examined with voxel-based morphometry procedures. RESULTS Reduced PFC density values were observed in T2DM patients compared to controls (left, 0.41 ± 0.02 mm3 /voxel vs 0.44 ± 0.02 mm3 /voxel, P < 0.001; right, 0.41 ± 0.03 mm3 /voxel vs 0.45 ± 0.02 mm3 /voxel, P < 0.001). PFC density values were positively correlated with cognition; left PFC region (r = 0.53, P = 0.005) and right PFC region (r = 0.56, P = 0.003), with age and sex as covariates. Significant negative correlations were found between PFC densities and HbA1c values; left PFC region (r = -0.39, P = 0.049) and right PFC region (r = -0.48, P = 0.01), with age and sex as covariates. CONCLUSIONS T2DM patients showed PFC brain tissue damage, which is associated with cognitive deficits and poor glycemic control. Further research is needed to identify causal relationships between HbA1c, cognition, and brain changes in T2DM and to evaluate the impact of interventions to prevent brain tissue injury or neuroregeneration in this high-risk patient population, to eventually preserve or enhance cognition and improve glucose outcomes.
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Affiliation(s)
- Sarah E Choi
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Bhaswati Roy
- Department of Anesthesiology, David Geffen School of Medicine, Los Angeles, California
| | - Matthew Freeby
- Division of Endocrinology, Diabetes, & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Rashmi Mullur
- Division of Endocrinology, Diabetes, & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mary A Woo
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine, Los Angeles, California
- Radiological Sciences, University of California Los Angeles, Los Angeles, California
- Bioengineering, University of California Los Angeles, Los Angeles, California
- Brain Research Institute, University of California Los Angeles, Los Angeles, California
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15
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Quality of Life in Type 2 Diabetes Mellitus Patients with Neuropsychological Deficits. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1196:41-61. [PMID: 32468306 DOI: 10.1007/978-3-030-32637-1_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We investigated: (i) the cognitive performance of type 2 diabetes mellitus (T2DM) patients compared to healthy control participants and (ii) the Health-related Quality of life (HRQOL) of type 2 diabetics with neuropsychological deficits. METHOD We conducted a prospective study in (N = 44) T2DM patients and (N = 28) demographically matched healthy controls. All participants were assessed with a flexible comprehensive neuropsychological battery of tests that have been standardized in Greece and found to be sensitive in detecting cognitive deficits in type 2 diabetics. They were additionally assessed on measures of general intelligence, general mental state, and depression. They were also administered the WHO QOL-BREF self-report questionnaire to evaluate perceived health-related quality of life. RESULTS Groups were well matched on baseline demographic characteristics and estimated premorbid intelligence. The groups did not differ on general mental state but varied in the encoding of verbal material, total verbal learning, delayed recall of verbal information, mental information processing speed, phonological and semantic verbal fluency and executive functions, set-shifting. Glycosylated hemoglobin levels and an interaction of age, education, and premorbid intelligence were the most important predictors of domain-specific neuropsychological performance. T2DM patients with deficits in verbal learning, executive functions, set-shifting, and semantic verbal fluency, had significantly lower QOL in the domains of psychological and environmental health, social relationships, and general health, respectively. CONCLUSION T2DM patients have cognitive deficits on several domains compared to healthy participants. Domain specific neuropsychological deficits in middle aged T2DM patients have a significant impact on HRQOL.
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Yu X, Zhang L, Yu R, Yang J, Zhang S. Discharge pharmacotherapy for Type 2 diabetic inpatients at two hospitals of different tiers in Zhejiang Province, China. PLoS One 2020; 15:e0230123. [PMID: 32267843 PMCID: PMC7141672 DOI: 10.1371/journal.pone.0230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022] Open
Abstract
Objects To look into the discharge pharmacotherapy for type 2 diabetics admitted to two general hospitals of different ranks and inspect current real-world management of discharge pharmacology and its related factors. Methods Type 2 diabetics admitted to a tertiary general hospital (Ningbo Medical Treatment Centre Lihuili Hospital, LHLH) or a secondary general hospital (Simen Hospital, SMH) for intensification of their anti-diabetics were included for retrospective analysis. Patients’ demographics, clinical characteristics, admission diabetes therapy and discharge diabetes pharmacology were analyzed and compared among patients in each hospital as well as between two hospitals. Results 391 patients from LHLH and 164 patients from SMH were included for analyzing. Compared with patients from LHLH, patients from SMH were older, more illiterate and had higher HbA1c concentrations. While there was a nearly equal split of oral anti-diabetes drugs (OADs)-only and Insulin treatment in LHLH’s discharge pharmacotherapy, insulin treatment dominated SMH’s. Basal-and-bolus insulin assumed the majority of SMH’s insulin regimens but only accounted for less than 20% of LHLH’s. The principal discrepancy in OADs-only treatment existed in the utilization of newer classes of OADs. Cost and body mass index (BMI) were the main differentiating factors among OADs-only treatments while duration, BMI and HbA1c differ among insulin treatments at LHLH. Clinical characteristics didn’t significantly differ among OADs-only treatments and HbA1c was the only differentiating factor among insulin treatments at SMH. Overall, hospital, duration, HbA1c, and vascular diseases were main factors that affect discharge pharmacology. Conclusions Great disparities exist in the discharge pharmacotherapy at two hospitals. Diabetes management is mostly glucose-oriented at SMH while multifactorial considerations were reflected in LHLH’s discharge pharmacotherapy. Besides differences in patients’ demographics, medication availability and diagnosis of early-stage vascular complications, lack of practical algorithm for discharge management in T2DM may be the underlying deficiency and a key part for future improvement.
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Affiliation(s)
- Xiaofang Yu
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
- * E-mail:
| | - Long Zhang
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
| | - Rongbin Yu
- Department of Preventive Care and Medical Insurance in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
| | - Jiao Yang
- Medical Department in Simen Hospital, Yuyao City, Ningbo, Zhejiang Province, China
| | - Saifei Zhang
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
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Yang J, Zhang Z, Zhang L, Su Y, Sun Y, Wang Q. Relationship Between Self-Care Behavior and Cognitive Function in Hospitalized Adult Patients with Type 2 Diabetes: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:207-214. [PMID: 32099427 PMCID: PMC6996216 DOI: 10.2147/dmso.s236966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/17/2020] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Jin Yang
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing100191, People’s Republic of China
| | - Zhenzhen Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing400016, People’s Republic of China
| | - Lijie Zhang
- Peking University School of Nursing, Beijing100191, People’s Republic of China
| | - Ye Su
- Peking University School of Nursing, Beijing100191, People’s Republic of China
| | - Yumei Sun
- Peking University School of Nursing, Beijing100191, People’s Republic of China
- Correspondence: Yumei Sun Peking University School of Nursing, Beijing100191, People’s Republic of ChinaTel +86-10-13641042422Fax +86-10-82266722 Email
| | - Qun Wang
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing100191, People’s Republic of China
- Qun Wang Department of Endocrinology and Metabolism, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing100191, People’s Republic of ChinaTel +86-10-15611908590Fax +86-10-82265025 Email
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Luciani M, Fabrizi D, Rebora P, Rossi E, Di Mauro S, Kohl Malone S, Ausili D. Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO). PROFESSIONI INFERMIERISTICHE 2019; 72:203-12. [PMID: 31884779 DOI: 10.7429/pi.2019.723203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.
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Affiliation(s)
- Michela Luciani
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e
Chirurgia. Monza, Italy
| | - Diletta Fabrizi
- RN, MSc, PhDs. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy. Corrispondence e-mail:
| | - Paola Rebora
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Emanuela Rossi
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Stefania Di Mauro
- RN, MSc. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Susan Kohl Malone
- PhD. New York University, Rory Meyers College of Nursing. New York, USA
| | - Davide Ausili
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
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Espeland MA, Dutton GR, Neiberg RH, Carmichael O, Hayden KM, Johnson KC, Jeffery RW, Baker LD, Cook DR, Kitzman DW, Rapp SR. Impact of a Multidomain Intensive Lifestyle Intervention on Complaints About Memory, Problem-Solving, and Decision-Making Abilities: The Action for Health in Diabetes Randomized Controlled Clinical Trial. J Gerontol A Biol Sci Med Sci 2019; 73:1560-1567. [PMID: 29846553 DOI: 10.1093/gerona/gly124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Lifestyle interventions to reduce weight and increase activity may preserve higher-order cognitive abilities in overweight/obese adults with type 2 diabetes (T2D). Methods Adults (N = 5,084) with T2D who enrolled in a randomized clinical trial of a 10-year intensive lifestyle intervention (ILI) compared with diabetes support and education were queried at baseline and repeatedly during follow-up for complaints about difficulties in memory, problem-solving, and decision-making abilities. Results For those without baseline complaints, assignment to ILI was associated with lower odds that complaints would emerge during follow-up for decision-making ability (odds ratio [OR]=0.851, [95% CI, 0.748,0.967], p=0.014), and, among individuals who were not obese, lower odds that complaints would emerge about problem-solving ability (OR=0.694 [0.510,0.946]). No cognitive benefits from ILI were seen for individuals with baseline complaints about cognitive abilities. ILI may have exacerbated the severity of complaints about problem-solving ability during follow-up among individuals with baseline complaints and cardiovascular disease (OR=2.949 [1.378,6.311]). Conclusions A long-term multidomain ILI may reduce the likelihood that complaints about difficulties in higher-order cognitive abilities will emerge in T2D adults without pre-existing complaints. Among those with pre-existing complaints, the ILI did not prevent increases in complaint severity.
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Affiliation(s)
- Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Owen Carmichael
- Institute for Dementia Research and Prevention, Pennington Biomedical Research Center, Baton Rouge, Los Angeles
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Laura D Baker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Delilah R Cook
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane W Kitzman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Psychiatry and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Turrin KB, Trujillo JM. Effects of Diabetes Numeracy on Glycemic Control and Diabetes Self-Management Behaviors in Patients on Insulin Pump Therapy. Diabetes Ther 2019; 10:1337-1346. [PMID: 31148053 PMCID: PMC6612337 DOI: 10.1007/s13300-019-0634-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Diabetes numeracy (DN) skills are crucial in patients on insulin pump therapy. Little evidence exists regarding DN in this patient population. METHODS This exploratory, observational, cross-sectional study assessed the DN levels of patients on insulin pump therapy and potential relationships with glycemic control and self-management behaviors. Seventy-two patients on insulin pump therapy were recruited from one specialty endocrinology clinic. Subjects completed validated tools to measure DN [Diabetes Numeracy Test (DNT-15)] and self-management behaviors [Diabetes Self-Management Questionnaire (DSMQ)]. A general diabetes questionnaire assessed socioeconomic information and self-efficacy. Additional self-management behaviors and glycemic control data were collected from patients' medical records. Patients were categorized into two groups based on DNT-15 scores to explore potential relationships between DN scores and patient characteristics, glycemic control, and self-management behaviors. RESULTS Average age was 52 ± 15 years, glycosylated hemoglobin (A1C) was 7.7% ± 1.2% (61 mmol/mol), duration of diabetes was 28 ± 15 years, and duration of pump use was 3.4 ± 1.3 years. The average DNT-15 score was 87.5% ± 18%. Forty-three participants (60%) scored ≥ 90% and 29 participants (40%) scored < 90%. Eighteen percent were unable to calculate the carbohydrate content from a nutrition label. Participants with lower DNT-15 scores had higher A1C levels (8.0% vs. 7.5%, p = 0.04), were older (58.3 vs. 47.7, p = 0.003), were more likely to describe their diabetes self-care as poor (p = 0.04), and were less confident in using their pump features (p = 0.02) than those with higher DNT-15 scores. CONCLUSION Many patients on insulin pump therapy have deficiencies with DN which may be associated with older age and higher A1C levels.
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Affiliation(s)
- Kali B Turrin
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jennifer M Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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Callisaya ML, Beare R, Moran C, Phan T, Wang W, Srikanth VK. Type 2 diabetes mellitus, brain atrophy and cognitive decline in older people: a longitudinal study. Diabetologia 2019; 62:448-458. [PMID: 30547230 DOI: 10.1007/s00125-018-4778-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS The aims of the study were to examine whether type 2 diabetes mellitus is associated with greater brain atrophy and cognitive decline, and whether brain atrophy mediates associations between type 2 diabetes and cognitive decline. METHODS Participants without dementia aged 55-90 years from the Cognition and Diabetes in Older Tasmanians (CDOT) study underwent brain MRI (ventricular and total brain volume) and neuropsychological measures (global function and seven cognitive domains) at three time points over 4.6 years. Mixed models were used to examine longitudinal associations of type 2 diabetes with cognitive and MRI measures, adjusting for covariates. A test of mediation was used to determine whether brain atrophy explained associations between type 2 diabetes and cognitive decline. RESULTS A total of 705 participants (diabetes: n = 348, mean age 68.2 years [SD 7.0]; no diabetes: n = 357, mean age 72.5 years [SD 7.1]) were available at baseline. Adjusting for age, sex, education and vascular risk factors, there were significant diabetes × time interactions for verbal memory (β -0.06; 95% CI -0.09, -0.02) and verbal fluency (β -0.03; 95% CI -0.06, -0.00). Although people with diabetes had lower brain (β -14.273; 95% CI -21.197, -6.580) and greater ventricular (β 2.672; 95% CI 0.152, 5.193) volumes at baseline, there were no significant diabetes × time interactions (p > 0.05) or evidence of mediation of the diabetes-cognition relationship by brain atrophy. CONCLUSIONS/INTERPRETATION In older community-dwelling people, type 2 diabetes is associated with decline in verbal memory and fluency over ~5 years. The effect of diabetes on brain atrophy may begin earlier (midlife).
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Affiliation(s)
- Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Private Bag 23, Hobart, TAS, 7000, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
| | - Richard Beare
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Chris Moran
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Frankston Hospital, Peninsula Health, Melbourne, VIC, Australia
- Department of Aged Care, Alfred Health, Melbourne, VIC, Australia
| | - Thanh Phan
- Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Wei Wang
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Velandai K Srikanth
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Private Bag 23, Hobart, TAS, 7000, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Frankston Hospital, Peninsula Health, Melbourne, VIC, Australia
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Lee L, Patel T, Molnar F, Seitz D. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e366-e372. [PMID: 30209109 PMCID: PMC6135142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Fournir aux médecins de première ligne une approche relative à l’optimisation de la pharmacothérapie chez les personnes âgées présentant un déficit cognitif. Sources d’information L’approche est fondée sur un programme agréé de formation clinique sur la mémoire, élaboré par le Centre for Family Medicine Primary Care Collaborative Memory Clinic. Message principal La démence augmente le risque d’événements indésirables d’origine médicamenteuse, et s’ajoute à la complexité et aux difficultés déjà présentes dans la prestation de soins optimaux chez les personnes âgées atteintes de démence. Les facteurs dont il faut tenir compte sont l’observance de la pharmacothérapie, les cibles thérapeutiques appropriées pour les comorbidités, la dose minimale de médicaments dotés d’effets indésirables cognitifs potentiels, et l’usage rationnel et la surveillance des médicaments qui améliorent la cognition. Les plans de pharmacothérapie doivent être individualisés et s’appuyer sur les objectifs de soins. Conclusion Les médecins de première ligne doivent tenir compte de nombreux facteurs pour optimiser la pharmacothérapie chez les personnes aux prises avec un déficit cognitif.
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Affiliation(s)
- Linda Lee
- Médecin de famille au Center for Family Medicine à Kitchener (Ontario), titulaire de la chaire de recherche Schlegel en soins primaires chez les aînés au Schlegel-UW Research Institute for Aging et professeure clinique agrégée au Département de médecine familiale de l'Université McMaster.
| | - Tejal Patel
- Pharmacienne de l'équipe de santé familiale au Centre for Family Medicine et professeure clinique adjointe à l'École de pharmacie de l'Université de Waterloo (Ontario)
| | - Frank Molnar
- Gériatre à Ottawa, (Ontario), directeur médical du Programme gériatrique régional de l'Est de l'Ontario et professeur agrégé à la Faculté de médecine de l'Université d'Ottawa
| | - Dallas Seitz
- Psychiatre en gériatrie à Kingston, et professeur agrégé, scientifique clinique et directeur de la Division de psychiatrie gériatrique à l'Université Queen's
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Lee L, Patel T, Molnar F, Seitz D. Optimizing medications in older adults with cognitive impairment: Considerations for primary care clinicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:646-652. [PMID: 30209094 PMCID: PMC6135130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide primary care physicians with an approach to medication optimization in older adults with cognitive impairment. SOURCES OF INFORMATION The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. MAIN MESSAGE Dementia increases the risk of medication-related adverse events and adds to the complexity and challenge of providing optimal care for these older adults. Considerations include medication adherence, appropriate therapeutic targets for comorbid conditions, minimized use of medications with potentially adverse cognitive effects, and rational use and monitoring of cognition-enhancing drugs. Medication management plans must be individualized and based on goals of care. CONCLUSION Primary care physicians must consider many factors in optimizing medications for those with cognitive impairment.
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Affiliation(s)
- Linda Lee
- Family physician at the Centre for Family Medicine Family Health Team in Kitchener, Ont, Schlegel Research Chair in Primary Care for Elders at the Schlegel-UW Research Institute for Aging, and Associate Clinical Professor in the Department of Family Medicine at McMaster University.
| | - Tejal Patel
- Pharmacist at the Centre for Family Medicine Family Health Team and Assistant Clinical Professor in the School of Pharmacy at the University of Waterloo in Ontario
| | - Frank Molnar
- Geriatrician in Ottawa, Ont, Medical Director of the Regional Geriatric Program of Eastern Ontario, and Associate Professor in the Department of Medicine at the University of Ottawa
| | - Dallas Seitz
- Geriatric psychiatrist in Kingston and Associate Professor, Clinician Scientist, and Chair of the Division of Geriatric Psychiatry at Queen's University
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Sarfati D, McLeod M, Stanley J, Signal V, Stairmand J, Krebs J, Dowell A, Leung W, Davies C, Grainger R. BetaMe: impact of a comprehensive digital health programme on HbA1c and weight at 12 months for people with diabetes and pre-diabetes: study protocol for a randomised controlled trial. Trials 2018; 19:161. [PMID: 29506562 PMCID: PMC5836439 DOI: 10.1186/s13063-018-2528-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/05/2018] [Indexed: 01/06/2023] Open
Abstract
Background Long-term conditions (LTCs) are the biggest contributor to health loss in New Zealand. The economic cost and burden on the health system is substantial and growing. Self-management strategies offer a potential way to reduce the pressure on health services. This study evaluates a comprehensive self-management programme (the BetaMe programme) delivered by mobile and web-based technologies for people with Type 2 diabetes (T2DM) and pre-diabetes. The primary aim of this study is to evaluate the effectiveness of the BetaMe programme versus usual care among primary care populations in improving the control of T2DM and pre-diabetes, as measured by change in HbA1c and weight over 12 months. Methods Participants will be recruited through two primary healthcare organisations and a Māori healthcare provider in New Zealand (n = 430). Eligible participants will be 18 to 75 years old, with T2DM or pre-diabetes, with an HbA1c of 41–70 mmol/mol up to 2 years prior to study commencement. Eligible participants who consent to participate will be individually randomised to the control arm (usual care) or intervention arm (usual care and BetaMe). The programme consists of a 16-week core followed by a maintenance period of 36 weeks. It incorporates (1) individualised health coaching, (2) goal setting and tracking, (3) peer support in an online forum and (4) educational resources and behaviour-change tools. The primary outcome measures are change in HbA1c and weight at 12 months. Secondary outcomes are changes in waist circumference, blood pressure, patient activation and diabetes-specific behaviours. All outcomes will be assessed at 4 and 12 months for the total study population and for Māori and Pacific participants specifically. All primary analyses will be based on intention-to-treat. Primary analysis will use linear mixed models comparing mean outcome levels adjusted for initial baseline characteristics at 12 months. Discussion This is a randomised controlled trial of a comprehensive self-management intervention for people with diabetes and pre-diabetes. If effective, this programme would allow healthcare providers to deliver an intervention that is person-centred and supports the self-care of people with T2DM, pre-diabetes and potentially other LTCs. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000549325. Registered on 19 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2528-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand.
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - William Leung
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, New Zealand.,Department of Medicine, University of Auckland, PO Box 1142, Auckland, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
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Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach. Int J Integr Care 2017; 17:2. [PMID: 29588635 PMCID: PMC5854149 DOI: 10.5334/ijic.3067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.
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Browne JL, Holmes-Truscott E, Ventura AD, Hendrieckx C, Pouwer F, Speight J. Cohort profiles of the cross-sectional and prospective participant groups in the second Diabetes MILES-Australia (MILES-2) study. BMJ Open 2017; 7:e012926. [PMID: 28246132 PMCID: PMC5337738 DOI: 10.1136/bmjopen-2016-012926] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE More research into the psychosocial aspects of diabetes is needed so that the health and quality of life of people with the condition can be improved. To fill this gap, we conducted the second Diabetes MILES-Australia study (MILES-2), a survey focused on psychological, behavioural and social aspects of diabetes. The aim of the MILES-2 study was to provide a (1) longitudinal follow-up of the original MILES 2011 study cohort; (2) cross-sectional assessment of a new cohort. PARTICIPANTS Eligible participants were English-speaking Australians with type 1 or type 2 diabetes, aged 18-75 years. Longitudinal cohort participants were mailed/emailed study invitations directly by researchers. Random sampling (stratified by diabetes type, insulin use, state) of the National Diabetes Services Scheme (NDSS) database and nationwide advertisements were used to recruit new cohort participants. The final sample included N=2342 eligible respondents (longitudinal cohort: n=504; 2015 new cohort: n=1838); 54% had type 2 diabetes. FINDINGS TO DATE Survey respondents were from an advantaged socioeconomic background compared to the general population. Respondents with type 1 diabetes were over-represented in the new cohort (45%) relative to the planned stratification (40% type 1 diabetes, 60% type 2 diabetes). Respondents with insulin-treated type 2 diabetes were under-represented in the new cohort relative to the stratified sampling (42% invited vs 50% response). Participants who completed both the 2011 and 2015 surveys were more likely than those completing the 2011 survey only to have type 1 diabetes, report a higher education and annual income, and live in metropolitan areas. Participant feedback indicated that the survey was perceived as relevant and valuable. FUTURE PLANS The depth and breadth of the data available in this large sample will highlight unmet needs and priority areas for future investigation and, crucially, will inform policy, programme and intervention development and evaluation in Australia.
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Affiliation(s)
- Jessica L Browne
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Adriana D Ventura
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- AHP Research, Hornchurch, Essex, UK
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Allan JL, McMinn D, Daly M. A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions. Front Neurosci 2016; 10:386. [PMID: 27601977 PMCID: PMC4993812 DOI: 10.3389/fnins.2016.00386] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/08/2016] [Indexed: 02/03/2023] Open
Abstract
Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.
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Affiliation(s)
- Julia L. Allan
- Health Psychology, Institute of Applied Health Sciences, University of AberdeenAberdeen, UK
| | - David McMinn
- Health Psychology, Institute of Applied Health Sciences, University of AberdeenAberdeen, UK
| | - Michael Daly
- Behavioural Science Centre, Stirling Management School, University of StirlingStirling, UK
- UCD Geary Institute, University College DublinDublin, Ireland
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