Management of Adults With Diabetes and Cognitive Problems

Management of diabetes involves a high degree of patient involvement and daily performance of many self-care tasks. These include monitoring of blood glucose; eating healthy meals; engaging in physical activity; taking medications as directed; recognizing and managing hypoglycemia; performing proper hygiene, including foot and dental care; attending medical appointments; and understanding sick-day management (1,2). Pharmacological therapy, particularly when insulin is needed, can be complex. Social, physical, and mental health challenges may hinder self-care and are associated with increased diabetes complications and poor quality of life (3). Cognitive impairment is a common, underdiagnosed complication of diabetes that can interfere with the ability to adequately perform required daily self-management behaviors (Table 1) (4). Mild-to-moderate cognitive impairment and dementia are more frequently observed in older adults, but declines in cognitive function also have been described in younger people with diabetes (5,6). It is estimated that at least half of older people with diabetes will become cognitively impaired and functionally disabled (7). Deficiencies in memory capacity, attention to detail, planning, ability to reason, decision-making, and information processing speed are associated with deficits in diabetes self-care behaviors, including poor compliance with medication, diet, and exercise recommendations; failure to receive appropriate care; and worse glycemic control, including more hypoglycemia (7–12). View this table: TABLE 1. Daily Diabetes Self-Management Tasks Affected by Cognitive Impairment A three-stage classification of cognitive dysfunction in patients with diabetes has been proposed (13). In the first stage, there are mild, subtle changes in cognition that might represent normal cognitive aging. These deficits are unlikely to significantly interfere with activities of daily living or self-management of diabetes in adults with type 2 diabetes treated with oral medications, but they may cause difficulties for patients requiring complex insulin regimens (i.e., those with type 1 diabetes or advanced type 2 diabetes). This …