Elderly diabetics with poor glucose control have a high prevalence of undiagnosed cognitive dysfunction, depression and functional disabilities. Dr. Medha Munshi, of the Joslin Diabetes Center, and colleagues examined the association between cognitive dysfunction and glycemic control in 60 diabetics older than 70 years who had a mean diabetes duration of about 14 years and a mean HbA1c of 7.9%.
The Mini Mental State Examination and a clock-drawing test and a clock-in-a-box test were used to screen for cognitive dysfunction. The subjects also completed the Geriatric Depression Scale and questionnaires to evaluate functional disabilities.
Overall, the Mini Mental State Examination scores correlated with the clock-in-a box and clock-drawing test scores. Thirty-five percent had low clock-in-a-box scores and 38% had low clock-drawing test scores, which were both inversely correlated with cognitive function. This suggests an association between cognitive dysfunction and poor glycemic control.
The 33% of subjects with depressive symptoms also had greater difficulty completing tasks on the instrumental activities of daily living survey.
This population of older diabetics had a high incidence of functional disabilities. Overall, 48% had hearing impairments, 53% had vision impairments, 33% had recently fallen, and 44% were afraid of falling.
No association was observed between depression scores and glycemic control.
"Elderly patients with diabetes require special and specific treatment plans," states Dr. Munshi. "Elderly patients with diabetes should be screened for the presence of co-existing medical conditions like cognitive dysfunction, depression, and physical disabilities as these conditions may act as barriers to their ability to self-manage."
"Now that we have identified potential barriers to self-management in elderly patients with diabetes, we would like to develop a comprehensive intervention strategy to overcome these barriers," Dr. Munshi said.
"These interventions will include modification of treatment modalities, focused education, nutrition counseling, and care coordination with the help of a multidisciplinary team," she explained. "The goal for the intervention would be to improve glycemic control, functional status, and quality of life in cost-effective fashion."
Diabetes Care 2006;29:1794-1799.
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