The association of mental conditions with blood glucose levels in older adults with diabetes

Abstract

Objectives People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions that can co-occur with diabetes are associated with blood glucose levels. Methods We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C. Results Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels. Conclusions Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.

P2‐260: Diabetes is associated with worse executive function in both eastern and western populations: Shanghai aging study and mayo clinic study of aging

“…Individuals with DM in both the SAS and MCSA samples demonstrated considerably worse performance in executive function compared to non-DM participants, consistent with previous reports [1,30,31]. In a large sample of 1900 non-demented people in a population-based study, subjects with diagnosed diabetes had worse executive function and slower processing speed compared to normoglycemics [32] In a cross-sectional study of 563 elderly diabetics, decreasing hemoglobin A1c level was associated with improvement in executive function [ [1,30,31]; the study did not include non-diabetics as in the present study thus the estimates magnitude of the differences may have been biased toward the null. In small study (n=40) of elderly diabetics and non-diabetics (a convenience sample), diabetics performed worse on the test of executive function compared to non-diabetics [33].…”

“…We observed a mild to moderate detrimental effect of DM on cognition, with the effect sizes ranging from 0.10-0.25 standard deviation (SD). This is slightly lower than reported for hospital-based studies [31,42], and is understandable considering the potential sample selection bias in clinic-based studies that typically include subjects with more severe disease. Moreover, according to our previous comparison between the participants and nonparticipants in the two study samples [12,13], the non-participants or telephone-interviewed subjects were older and had more vascular comorbidities which would have biased our estimates.…”

Patterns and Stability over Time of Older Adults' Diabetes-related Beliefs

“…The current study is based on data collected in the second project phase. Key features of the study design, including recruitment and data collection procedures are described elsewhere 8,14,15 and summarized here.…”

Inside the Diabetic Brain

“…Animal studies in rodents with streptozotocin-induced diabetes (T1DM model) have demonstrated structural changes in grey and white matter, dendritic atrophy in the CA3 hippocampal pyramidal neurons and neurobehavioral deficits associated with impaired hippocampal long-term potentiation (10,11). T2DM patients have also been found to have specific and global cognitive deficits in psychomotor speed, executive functions, memory skills, verbal fluency, attention and visuospatial abilities (12,13,14). Longitudinal studies have identified significantly higher risk of developing dementia or cognitive decline in diabetic patients and also suppose the link between T2DM and the risk of Alzheimer's disease (AD) (15,16).…”