Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment

Abstract

The primary objective of the study was to determine whether a distanced-based educational intervention would result in positive health outcomes for persons with both DM and cognitive impairment. Older adults with Type 2 diabetes (Diabetes Mellitus—DM) who also have cognitive impairment such as Mild Cognitive Impairment (MCI) or early stage dementia are both challenged and at risk when attempting to live independently. The ability to effectively monitor blood glucose levels and diet and exercise regimens often is severely constrained by the combination of DM and the presence of Mild Cognitive Impairment (MCI) or early stage dementia. We describe an exploratory study funded by the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK) in which Certified Diabetic Educators (CDEs) were linked with 40 older adult with DM and cognitive impairment using iPads and the internet. CDEs presented personalized education sessions to participants, and 18 of the participants also received a cognitive intervention called Spaced Retrieval (SR), which is designed to train the effective use of strategies to enhance medication compliance and reach other goals. Blood glucose and cholesterol measures were assessed at baseline and at 2-, 4-, and 6-month post intervention. Hemoglobin A1c (HbA1c) levels initially declined from baseline after treatment but returned to baseline levels after 6 months. For low-density lipoprotein (LDL) cholesterol, a significant interaction effect was found for the Group × Time interaction. LDL levels increased from baseline after treatment for the control group, but showed decline after baseline in the SR group. Goals that were initially learned were retained, in general, at short-term follow-up, and self-efficacy increased significantly after training. Results show the need for follow-up and support after initial treatment, as well as the need to see if the effects produced by SR can be replicated and sustained with continued contact.