OBJECTIVE -To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes.RESEARCH DESIGN AND METHODS -Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities.RESULTS -Sixty patients (age 79 Ϯ 5 years, diabetes duration 14 Ϯ 13 years) were evaluated. Thirty-four percent of patients had low CIB (Յ5), and 38% of patients had low CDT (Յ13). Both CIB as well as CDT were inversely correlated with HbA 1c , suggesting that cognitive dysfunction is associated with poor glycemic control (r ϭ Ϫ0.37, P Ͻ 0.004 and r ϭ Ϫ0.38, P Ͻ 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 Ϯ 1.7 vs. 4.6 Ϯ 2.0; P Ͻ 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%).CONCLUSIONS -Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

BackgroundVirtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost.ObjectiveWe tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention.MethodsWe recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent, a behavior-change in-person group program for African Americans with diabetes or pre-diabetes. The program is social cognitive theory–guided, evidence-based, and culturally tailored. Participants were randomized to participate in the program via virtual world (Second Life) or face-to-face, both delivered by a single intervention team. Blinded assessors conducted in-person clinical (HbA1c), behavioral, and psychosocial measurements at baseline and 4-month follow-up. Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests (two-sided and intention-to-treat analyses for all comparisons).ResultsParticipants (N=89) were an average of 52 years old (SD 10), 60% had ≤high school, 82% had household incomes

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