Impact of Cognitive Impairment on Adherence to Treatment and Self-Care in Patients with Type 2 Diabetes Mellitus

Natalia Świątoniowska-Lonc; Jacek Polański; Wojciech Tański; Beata Jankowska-Polańska

doi:10.2147/DMSO.S284468

Impact of Cognitive Impairment on Adherence to Treatment and Self-Care in Patients with Type 2 Diabetes Mellitus

Diabetes Metab Syndr Obes. 2021 Jan 15:14:193-203. doi: 10.2147/DMSO.S284468. eCollection 2021.

Authors

Natalia Świątoniowska-Lonc¹, Jacek Polański², Wojciech Tański³, Beata Jankowska-Polańska¹

Affiliations

¹ Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
² Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland.
³ Department of Internal Medicine, 4th Military Teaching Hospital, Wroclaw, Poland.

Abstract

Background: Elderly patients with diabetes have a significantly increased prevalence of mild cognitive impairment compared with people of similar age without diabetes. Tasks related to diabetes self-management involve multiple cognitive skills and processes, such as memory, attention, planning, and calculating. Impaired cognitive function can threaten the patient's ability to perform self-monitoring. The objectives of the study were: to assess cognitive deficits and the level of self-care in elderly patients with diabetes, to identify correlations between cognitive deficits and self-care, and to determine which variables influence self-care behaviors and cognitive deficits.

Methods: The study involved 169 patients with type 2 DM. Standardized tools were used: Mini-mental State Examination (MMSE) to assess cognitive function and the Self-Care of Diabetes Inventory (SCODI) to assess the level of self-care. Socioclinical data were taken from the hospital records.

Results: 56.8% of patients had cognitive impairment (MMSE≤26). In the comparative analysis, patients with cognitive impairment had significantly lower results in all domains of the SCODI: self-care maintenance (72.9 vs 75), self-care monitoring (53.1 vs 56.3), self-care management (71.9 vs 84.4), self-care confidence (79.5 vs 86.4). Correlation analysis showed that the MMSE score correlates significantly and positively (p˂0.05; r˃0) with all SCODI subscales, and the higher the MMSE score the higher the level of self-care (A: r=0.252, B: r=0.244, C: r=0.019, D: r=0.28).

Conclusion: In this elderly type 2 diabetes population, and using only one test to verify the cognitive function, self-care management was worse in terms of self-care management (blood glucose control). Cognitive function components are independent determinants of self-care in patients with type 2 diabetes. Recall is an independent predictor of self-care maintenance, and writing a predictor of self-care monitoring.

Keywords: adherence; cognitive impairment; diabetes; self-care.