Cognitive Function, Self-care, and Glycemic Control in Rural Adults with Type 2 Diabetes

Abstract

Cognitive Function, Self-Care, and Glycemic Control in Rural Adults with Type 2 Diabetes

Abstract The prevalence of type 2 diabetes mellitus (DM) has increased dramatically over the past two decades, particularly among adults living in rural communities. Related health complications include structural brain changes and decreased cognitive function. Cognitive decline associated with DM may influence one’s ability to perform self-care and affect glycemic control. In turn, poor glycemic control contributes to increased complications associated with DM. Although one’s ability to maintain glycemic control may be highly dependent on cognitive abilities, there is limited understanding about the relationship between cognitive function, self-care, and glycemic control in rural adults with DM. Specific aims of this study were to: 1) examine the relationships between cognitive function, glycemic control, and contributing factors (age, years with DM, education category, cardiovascular (CV) risk, level of depression) in rural adults with DM; 2) examine whether cognitive function predicts glycemic control in rural adults with DM; 3) examine the relationship between cognitive function, self-care, and contributing factors (age, years with DM, education category, everyday problem-solving, and level of depression) in rural adults with DM; and, 4) examine whether cognitive function predicts self-care in rural adults with DM. This descriptive study included a convenience sample of (N=56) rural adults with DM. A face-to-face interview was conducted with each participant, where performance of the cognitive processes of attention, executive function, mental processing speed, and verbal episodic memory was measured with neuropsychological tests. Frequencies of performing DM self-care activities of adherence to diet, exercise, blood glucose monitoring, foot care and medications were queried to determine levels of self-care, and a recent glycohemoglobin was obtained to determine glycemic control. Main results were that cognitive function in domains of attention, executive function, mental processing speed, or verbal episodic memory, after controlling for modifiable and non-modifiable covariates, did not independently explain glycemic control or the frequency of DM self-care activity performance by rural adults with DM. The covariates cardiovascular risk and depression independently explained cognitive function, and depression independently explained self-care performance.