Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment

Abstract

Aim To evaluate the effectiveness of a combined patient empowerment program (PEP) and cognitive training (CT) program on improving glycemic control among older subjects with diabetes and cognitive impairment. Methods A prospective single blinded, randomized controlled study was carried out in 139 older patients with diabetes aged ≥65 years with memory complaints and recent glycosylated hemoglobin level of 7–9%. They were randomly assigned to either undergo once‐weekly PEP combined with CT for 10 weeks (intervention group, N = 73) or receive no intervention (control group, N = 66). All participants were followed up at months 4 and 12 to examine the immediate and long‐term effects on glycemic control, cognition, mood and compliance to drug and diabetes self‐management. Results The intervention did not significantly reduce glycosylated hemoglobin. The intervention group showed significant progressive improvement in memory over 1 year and executive function improved significantly at month 12. There was no significant change in diabetes self‐management activities with the intervention. Conclusions Combination of PEP and CT did not improve glycemic control or self‐care activities in older patients with diabetes and memory complaints but was effective in improving cognitive function in the longer term. Geriatr Gerontol Int 2020; 20: 1164–1170.

Perceptions and responses to cognitive decline in people with diabetes: A systematic review of qualitative studies

“…However, some studies have shown different results. Wong et al found that the combination of patient empowerment and cognitive training did not improve glycemic control or self-care activities in older PWDs with memory complaints (56). A systematic review found moderate strength of evidence that cognitive training may improve performance in trained cognitive domains (57).…”

The Effectiveness of Cognitive-Focused Interventions for Adults With Diabetes: A Systematic Review

“…The participants were recruited from the community, inpatient, and outpatient clinics. Of the 11 studies, 8 were randomized controlled trials 20,30,31,[34][35][36][37][38] and 3 were quasiexperimental studies. 29,32,33 Study sample sizes ranged from 19 to 180, and the mean age of participants ranged from 55.1 to 74.6 years old.…”

Cognitive impairment in Diabetes Mellitus

“…Hyperglycemia is the main sign of type 1 diabetes mellitus (T1DM), T2DM, and GDM, resulting from a drop in insulin level to become inadequate for meeting the tissues' normal blood glucose demands. Hyperglycemia is found to be associated with cognitive decline in several reports [6,7]. Several studies have shown an association between cognitive impairment and glycated hemoglobin (HbA1c) [6,20,23].…”

“…Cognitive dysfunction in individuals with diabetes can result from interactions between inherent metabolic abnormalities, such as hyperglycemia, hyperinsulinemia, and micro-and macrovascular complications, in addition to comorbid conditions as hypertension, dyslipidaemia, depression, and obesity. [1,[5][6][7][8]. Many studies have raised concerns about the long-term consequences of poor glycemic control on the impairment of cognitive functions [9].…”