Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment
Author(s)
Cameron J. Camp1*,
Kathleen Fox1,
Michael J. Skrajner2,
Vincent Antenucci1,
Jessica Haberman1,3
Affiliation(s)
1 Center for Applied Research, Solon, USA. 2 Hearthstone Alzheimer’s Care, Woburn, USA. 3 Cleveland State University, Cleveland, USA.
1 Center for Applied Research, Solon, USA. 2 Hearthstone Alzheimer’s Care, Woburn, USA. 3 Cleveland State University, Cleveland, USA.
ABSTRACT
The primary objective of the study was to determine whether a distanced-based educational in-tervention would result in positive health outcomes for persons with both DM and cognitive impairment. Older adults with Type 2 diabetes (Diabetes Mellitus—DM) who also have cognitive impairment such as Mild Cognitive Impairment (MCI) or early stage dementia are both challenged and at risk when attempting to live independently. The ability to effectively monitor blood glucose levels and diet and exercise regimens often is severely constrained by the combination of DM and the presence of Mild Cognitive Impairment (MCI) or early stage dementia. We describe an exploratory study funded by the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK) in which Certified Diabetic Educators (CDEs) were linked with 40 older adult with DM and cognitive impairment using iPads and the internet. CDEs presented personalized education sessions to participants, and 18 of the participants also received a cognitive intervention called Spaced Retrieval (SR), which is designed to train the effective use of strategies to enhance medication compliance and reach other goals. Blood glucose and cholesterol measures were assessed at baseline and at 2-, 4-, and 6-month post intervention. Hemoglobin A1c (HbA1c) levels initially declined from baseline after treatment but returned to baseline levels after 6 months. For low-density lipoprotein (LDL) cholesterol, a significant interaction effect was found for the Group × Time interaction. LDL levels increased from baseline after treatment for the control group, but showed decline after baseline in the SR group. Goals that were initially learned were retained, in general, at short-term follow-up, and self-efficacy increased significantly after training. Results show the need for follow-up and support after initial treatment, as well as the need to see if the effects produced by SR can be replicated and sustained with continued contact.
The primary objective of the study was to determine whether a distanced-based educational in-tervention would result in positive health outcomes for persons with both DM and cognitive impairment. Older adults with Type 2 diabetes (Diabetes Mellitus—DM) who also have cognitive impairment such as Mild Cognitive Impairment (MCI) or early stage dementia are both challenged and at risk when attempting to live independently. The ability to effectively monitor blood glucose levels and diet and exercise regimens often is severely constrained by the combination of DM and the presence of Mild Cognitive Impairment (MCI) or early stage dementia. We describe an exploratory study funded by the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK) in which Certified Diabetic Educators (CDEs) were linked with 40 older adult with DM and cognitive impairment using iPads and the internet. CDEs presented personalized education sessions to participants, and 18 of the participants also received a cognitive intervention called Spaced Retrieval (SR), which is designed to train the effective use of strategies to enhance medication compliance and reach other goals. Blood glucose and cholesterol measures were assessed at baseline and at 2-, 4-, and 6-month post intervention. Hemoglobin A1c (HbA1c) levels initially declined from baseline after treatment but returned to baseline levels after 6 months. For low-density lipoprotein (LDL) cholesterol, a significant interaction effect was found for the Group × Time interaction. LDL levels increased from baseline after treatment for the control group, but showed decline after baseline in the SR group. Goals that were initially learned were retained, in general, at short-term follow-up, and self-efficacy increased significantly after training. Results show the need for follow-up and support after initial treatment, as well as the need to see if the effects produced by SR can be replicated and sustained with continued contact.
KEYWORDS
Type 2 Diabetes, Cognitive Impairment, Distance-Based Intervention, Educational Intervention, Spaced-Retrieval
Type 2 Diabetes, Cognitive Impairment, Distance-Based Intervention, Educational Intervention, Spaced-Retrieval
Cite this paper
Camp, C. , Fox, K. , Skrajner, M. , Antenucci, V. and Haberman, J. (2015) Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment. Advances in Aging Research, 4, 33-41. doi: 10.4236/aar.2015.42005.
Camp, C. , Fox, K. , Skrajner, M. , Antenucci, V. and Haberman, J. (2015) Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment. Advances in Aging Research, 4, 33-41. doi: 10.4236/aar.2015.42005.
References
[1] Ogden, C.L., Carroll, M.D., Kit, B.K. and Flegal, K.M. (2014) Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA, 311, 806-814.
http://dx.doi.org/10.1001/jama.2014.732 [2] Centers for Disease Control and Prevention (2014) National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. US Department of Health and Human Services, Atlanta. [3] National Diabetes Fact Sheet (2011)
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf [4] Wang, Y.C., McPherson, K., Marsh, T., Gortmaker, S.L. and Brown, M. (2011) Health and Economic Burden of the Projected Obesity Trends in the USA and the UK. The Lancet, 378, 815-825.
http://dx.doi.org/10.1016/S0140-6736(11)60814-3 [5] Zhang, P., Zhang, X., Brown, J., Vistisen, D., Sicree, R., Shaw, J. and Nichols, G. (2010) Global Healthcare Expenditure on Diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 293-301.
http://dx.doi.org/10.1016/j.diabres.2010.01.026 [6] Kanel, R., Dimsdale, J.E., et al. (2006) Poor Sleep Is Associated with Higher Plasma Proinflammatory Cytokine Interleukin-6 and Procoagulant Marker Fibrin D-Dimer in Older Caregivers of People with Alzheimer’s Disease. Journal of the American Geriatrics Society, 54, 431-437.
http://dx.doi.org/10.1111/j.1532-5415.2005.00642.x [7] Vitaliano, P.P., Russo, J., Scanlan, J.M. and Greeno, C.G. (1996) Weight Changes in Caregivers of Alzheimer’s Care Recipients: Psychobehavioral Predictors. Psychology and Aging, 11, 155.
http://dx.doi.org/10.1037/0882-7974.11.1.155 [8] Shaw, W.S., Patterson, T.L., Ziegler, M.G., Dimsdale, J.E., Semple, S.J. and Grant, I. (1999) Accelerated Risk of Hypertensive Blood Pressure Recordings among Alzheimer Caregivers. Journal of Psychosomatic Research, 46, 215-227.
http://dx.doi.org/10.1016/S0022-3999(98)00084-1 [9] Lee, S., Colditz, G.A., Berkman, L.F. and Kawachi, I. (2003) Caregiving and Risk of Coronary Heart Disease in US Women: A Prospective Study. American Journal of Preventive Medicine, 24, 113-119.
http://dx.doi.org/10.1016/S0749-3797(02)00582-2 [10] Alzheimer’s Association (2012) 2012 Alzheimer’s Disease Facts and Figures.
http://www.alz.org/downloads/facts_figures_2012.pdf [11] Stewart, R. and Liolitsa, D. (1999) Type 2 Diabetes Mellitus, Cognitive Impairment and Dementia. Diabetic Medicine, 16, 93-112.
http://dx.doi.org/10.1046/j.1464-5491.1999.00027.x [12] Coker, L.H. and Shumaker, S.A. (2003) Type 2 Di-abetes Mellitus and Cognition: An Understudied Issues in Women’s Health. Journal of Psychosomatic Research, 54, 129-139.
http://dx.doi.org/10.1016/S0022-3999(02)00523-8 [13] Ryan, C.M. and Geckle, M. (2000) Why Is Learning and Memory Dysfunction in Type 2 Diabetes Limited to Older Adults? Diabetes/Metabolism Research and Reviews, 16, 308-315.
http://dx.doi.org/10.1002/1520-7560(2000)9999:9999<::AID-DMRR141>3.0.CO;2-X [14] Haan, M. (2009) Type 2 Diabetes and Incidence of Dementia and Cognitive Decline: What Are the Mechanisms? Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 5, 123. [15] Anderson, R.J., Freedland, K.E., Clouse, R.E. and Lustman, P.J. (2001) The Prevalence of Comorbid Depression in Adults with Diabetes: A Meta-Analysis. Diabetes Care, 24, 1069-1078.
http://dx.doi.org/10.2337/diacare.24.6.1069 [16] Lin, E.H., Katon, W., Von Korff, M., Rutter, C., Simon, G.E., Oliver, M., Young, B., et al. (2004) Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care. Diabetes Care, 27, 2154-2160.
http://dx.doi.org/10.2337/diacare.27.9.2154 [17] Ciechanowski, P.S., Katon, W.J. and Russo, J.E. (2000) Depression and Diabetes: Impact of Depressive Symptoms on Adherence, Function, and Costs. JAMA Internal Medicine, 160, 3278-3285.
http://dx.doi.org/10.1001/archinte.160.21.3278 [18] Alzheimer’s Association (2014) 2013 Alzheimer’s Disease Facts and Figures.
http://www.alz.org/downloads/facts_figures_2013.pdf [19] Camp, C.J. (2006) Spaced Retrieval: A Case Study in Dissemination of a Cognitive Intervention for Persons with Dementia. In: Attix, D.K. and Welsch-Bohmner, K.A., Eds., Geriatric Neuropsychological Assessment and Intervention, The Guilford Press, New York, 275-292. [20] Brandt, J., Spencer, M. and Folstein, M. (1988) The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 1, 111-117. [21] Spreen, O. and Strauss, E. (1998) A Compendium of Neuropsychological Tests. Oxford University Press, New York, 447-459. [22] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6 [23] Talbot, F., Nouwen, A., Gingras, J., Gosselin, M. and Audent, J. (1997) The Assessment of Diabetes-Related Cognitive and Social Factors: The Multidimensional Diabetes Questionnaire. Journal of Behavioral Medicine, 20, 291-312.
http://dx.doi.org/10.1023/A:1025508928696 [24] Herrmann, N., Mitimann, N., Silver, I.L., Shulman, K.L., Busto, U., Shear, N.H. and Naranjo, C.A. (1996) A Validation Study of the Geriatric Depression Scale Short Form. International Journal of Geriatric Psychiatry, 11, 457-460.
http://dx.doi.org/10.1002/(SICI)1099-1166(199605)11:5<457::AID-GPS325>3.0.CO;2-2 [25] Camp, C.J., Skrajner, M.J., Antenucci, V., Frentiu, C. and Haberman, J. (2012) Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Memory Impairment. Gerontologist, 52, 130. [26] Sajatovic, M., Dawson, N.V., Perzynski, A., Blixen, C., Bialko, C., McKibbin, C., Bauer, M.S., Seeholzer, E., Kaiser, D. and Fuentes-Casiano, E. (2011) Optimizing Care for People with Serious Mental Illness and Comorbid Diabetes. Psychiatric Services (Best Practices Column), 62, 1001-1003.
http://dx.doi.org/10.1176/ps.62.9.pss6209_1001
[1] Ogden, C.L., Carroll, M.D., Kit, B.K. and Flegal, K.M. (2014) Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA, 311, 806-814.
http://dx.doi.org/10.1001/jama.2014.732 [2] Centers for Disease Control and Prevention (2014) National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. US Department of Health and Human Services, Atlanta. [3] National Diabetes Fact Sheet (2011)
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf [4] Wang, Y.C., McPherson, K., Marsh, T., Gortmaker, S.L. and Brown, M. (2011) Health and Economic Burden of the Projected Obesity Trends in the USA and the UK. The Lancet, 378, 815-825.
http://dx.doi.org/10.1016/S0140-6736(11)60814-3 [5] Zhang, P., Zhang, X., Brown, J., Vistisen, D., Sicree, R., Shaw, J. and Nichols, G. (2010) Global Healthcare Expenditure on Diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 293-301.
http://dx.doi.org/10.1016/j.diabres.2010.01.026 [6] Kanel, R., Dimsdale, J.E., et al. (2006) Poor Sleep Is Associated with Higher Plasma Proinflammatory Cytokine Interleukin-6 and Procoagulant Marker Fibrin D-Dimer in Older Caregivers of People with Alzheimer’s Disease. Journal of the American Geriatrics Society, 54, 431-437.
http://dx.doi.org/10.1111/j.1532-5415.2005.00642.x [7] Vitaliano, P.P., Russo, J., Scanlan, J.M. and Greeno, C.G. (1996) Weight Changes in Caregivers of Alzheimer’s Care Recipients: Psychobehavioral Predictors. Psychology and Aging, 11, 155.
http://dx.doi.org/10.1037/0882-7974.11.1.155 [8] Shaw, W.S., Patterson, T.L., Ziegler, M.G., Dimsdale, J.E., Semple, S.J. and Grant, I. (1999) Accelerated Risk of Hypertensive Blood Pressure Recordings among Alzheimer Caregivers. Journal of Psychosomatic Research, 46, 215-227.
http://dx.doi.org/10.1016/S0022-3999(98)00084-1 [9] Lee, S., Colditz, G.A., Berkman, L.F. and Kawachi, I. (2003) Caregiving and Risk of Coronary Heart Disease in US Women: A Prospective Study. American Journal of Preventive Medicine, 24, 113-119.
http://dx.doi.org/10.1016/S0749-3797(02)00582-2 [10] Alzheimer’s Association (2012) 2012 Alzheimer’s Disease Facts and Figures.
http://www.alz.org/downloads/facts_figures_2012.pdf [11] Stewart, R. and Liolitsa, D. (1999) Type 2 Diabetes Mellitus, Cognitive Impairment and Dementia. Diabetic Medicine, 16, 93-112.
http://dx.doi.org/10.1046/j.1464-5491.1999.00027.x [12] Coker, L.H. and Shumaker, S.A. (2003) Type 2 Di-abetes Mellitus and Cognition: An Understudied Issues in Women’s Health. Journal of Psychosomatic Research, 54, 129-139.
http://dx.doi.org/10.1016/S0022-3999(02)00523-8 [13] Ryan, C.M. and Geckle, M. (2000) Why Is Learning and Memory Dysfunction in Type 2 Diabetes Limited to Older Adults? Diabetes/Metabolism Research and Reviews, 16, 308-315.
http://dx.doi.org/10.1002/1520-7560(2000)9999:9999<::AID-DMRR141>3.0.CO;2-X [14] Haan, M. (2009) Type 2 Diabetes and Incidence of Dementia and Cognitive Decline: What Are the Mechanisms? Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 5, 123. [15] Anderson, R.J., Freedland, K.E., Clouse, R.E. and Lustman, P.J. (2001) The Prevalence of Comorbid Depression in Adults with Diabetes: A Meta-Analysis. Diabetes Care, 24, 1069-1078.
http://dx.doi.org/10.2337/diacare.24.6.1069 [16] Lin, E.H., Katon, W., Von Korff, M., Rutter, C., Simon, G.E., Oliver, M., Young, B., et al. (2004) Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care. Diabetes Care, 27, 2154-2160.
http://dx.doi.org/10.2337/diacare.27.9.2154 [17] Ciechanowski, P.S., Katon, W.J. and Russo, J.E. (2000) Depression and Diabetes: Impact of Depressive Symptoms on Adherence, Function, and Costs. JAMA Internal Medicine, 160, 3278-3285.
http://dx.doi.org/10.1001/archinte.160.21.3278 [18] Alzheimer’s Association (2014) 2013 Alzheimer’s Disease Facts and Figures.
http://www.alz.org/downloads/facts_figures_2013.pdf [19] Camp, C.J. (2006) Spaced Retrieval: A Case Study in Dissemination of a Cognitive Intervention for Persons with Dementia. In: Attix, D.K. and Welsch-Bohmner, K.A., Eds., Geriatric Neuropsychological Assessment and Intervention, The Guilford Press, New York, 275-292. [20] Brandt, J., Spencer, M. and Folstein, M. (1988) The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 1, 111-117. [21] Spreen, O. and Strauss, E. (1998) A Compendium of Neuropsychological Tests. Oxford University Press, New York, 447-459. [22] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6 [23] Talbot, F., Nouwen, A., Gingras, J., Gosselin, M. and Audent, J. (1997) The Assessment of Diabetes-Related Cognitive and Social Factors: The Multidimensional Diabetes Questionnaire. Journal of Behavioral Medicine, 20, 291-312.
http://dx.doi.org/10.1023/A:1025508928696 [24] Herrmann, N., Mitimann, N., Silver, I.L., Shulman, K.L., Busto, U., Shear, N.H. and Naranjo, C.A. (1996) A Validation Study of the Geriatric Depression Scale Short Form. International Journal of Geriatric Psychiatry, 11, 457-460.
http://dx.doi.org/10.1002/(SICI)1099-1166(199605)11:5<457::AID-GPS325>3.0.CO;2-2 [25] Camp, C.J., Skrajner, M.J., Antenucci, V., Frentiu, C. and Haberman, J. (2012) Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Memory Impairment. Gerontologist, 52, 130. [26] Sajatovic, M., Dawson, N.V., Perzynski, A., Blixen, C., Bialko, C., McKibbin, C., Bauer, M.S., Seeholzer, E., Kaiser, D. and Fuentes-Casiano, E. (2011) Optimizing Care for People with Serious Mental Illness and Comorbid Diabetes. Psychiatric Services (Best Practices Column), 62, 1001-1003.
http://dx.doi.org/10.1176/ps.62.9.pss6209_1001