Poor diabetes control tied to cognitive difficulty
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Elderly diabetics with poor blood sugar control have a high prevalence of undiagnosed cognitive dysfunction, depression and functional disabilities, according to a study by researchers in Boston.
Dr. Medha Munshi, of the Joslin Diabetes Center, and colleagues examined the association between cognitive dysfunction and blood sugar control in 60 diabetics older than age 70. These individuals had diabetes for an average of about 14 years and elevated hemoglobin A1C levels—an indicator of poor blood sugar control.
The mean HbA1C level was 7.9 percent. The American Diabetes Association recommends a target A1C level of 7.0 or lower.
Several common tests were used to screen for cognitive dysfunction such as the Mini Mental State Examination and standard drawing tests. The subjects were also screened for depression and functional disability.
Overall, the Mini Mental State Examination scores correlated with drawing test scores.
More than a third had low scores on the drawing tests and these scores were inversely correlated with cognitive function. This suggests an association between cognitive dysfunction and poor blood sugar control, the researchers report in Diabetes Care.
The 33 percent of subjects with depressive symptoms also had greater difficulty completing tasks of daily living.
This population of older diabetics had a high incidence of functional disabilities. Overall, 48 percent had hearing impairments, 53 percent had vision impairments, 33 percent had recently fallen, and 44 percent were afraid of falling.
No association was observed between depression scores and blood sugar control.
In an interview with Reuters Health, Munshi said: “Elderly patients with diabetes require special and specific treatment plans. 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.”
Elderly diabetics, she added, may benefit from “modification of treatment modalities, focused education, nutrition counseling, and care coordination with the help of a multidisciplinary team.”
SOURCE: Diabetes Care August 2006.
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