Cognitive Functioning and Self-Management in Older People With Diabetes

Abstract

The extent to which diabetes is responsible for cognitive dysfunction in older people continues to be investigated. Research is also being conducted to better understand why people with diabetes find self-management of their illness a challenge and to develop behavioral interventions to help older people improve their diabetes self-management. There is little research combining these two issues, that is, whether the level and type of cognitive impairment associated with diabetes affects people’s self-management. In this article, we review the evidence for deficits in cognitive functioning in older people with diabetes (predominantly type 2) and consider the implications for diabetes self-management. Case-control and epidemiological studies comparing cognitive functioning of older people with and without diabetes have yielded inconsistent findings. However, one may draw the broad conclusion that there is some evidence of decline in more complex aspects of cognitive function, such as verbal memory, learning, and psychomotor efficiency. Cognitive functioning is probably also adversely affected by age, illness duration, glycemic control, and the presence of other co-morbid conditions. People with diabetes are at increased risk for dementia. This research is limited by lack of consensus on cognitive measures across studies and small sample sizes limiting power to detect differences. We summarize the findings from our study relating cognitive functioning to self-management behaviors for older people with type 2 diabetes, in which we found only a few associations. On the basis of the available evidence, we conclude that the cognitive impairment associated with relatively uncomplicated type 2 diabetes in older adults is unlikely to adversely affect self-management of the illness.