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Reduced cognitive function associated with worse glycemic control in older adults with diabetes, increased social support for diabetes care tempers this association, findings reveal

Friday, October 30 2009 | Comments

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What's This? Reduced cognitive function among older Americans appears to be associated with worse glycemic control; however, higher levels of social support for diabetes care appear to modify this association, according to an analysis of data from a large, nationally representative sample.

Researchers conducted a cross-sectional analysis of individuals with diabetes aged 50 years or older who participated in the 2002 and 2004 waves of the Health and Retirement Study (HRS) as well as the 2003 HRS Survey on Diabetes. The participants included in the current analysis (n=1,097) provided a valid hemoglobin A1C sample (collected with an at-home test kit) as part of the 2003 survey.

Cognitive function was assessed with the 35-point HRS cognitive scale (HRS-cog). Social support was determined based on participant responses to 8 questions that asked about the level of support from family and friends that the participant received for different aspects of diabetes care.

In unadjusted and adjusted analyses, the individuals with HRS-cog scores in the lowest quartile had significantly higher A1C levels relative to their counterparts with scores in the highest quartile. In a fully adjusted model, the odds of worse glycemic control were 80% greater in the lowest HRS-cog quartile as compared with the highest quartile.

Among the respondents with HRS-cog scores in the lowest quartile, there was a statistically significant trend showing a lower risk of worse glycemic control with increasing levels of social support.

Specifically, the odds of worse glycemic control were nearly 2.9-fold greater among the individuals with both low cognitive scores (ie, the bottom quartile) and low levels of social support relative to the participants with high cognitive scores (ie, the top quartile) and high levels of social support. However, among individuals with low cognitive scores but high levels of social support, the odds of worse glycemic control were only 11% greater relative to the participants with high cognitive scores and high levels of social support.

"The results of the current study support a recent Institute of Medicine report that highlighted the importance of caregiver involvement in chronic illness management for older adults," the study authors wrote.

"Identifying the level of social support available to cognitively impaired adults with diabetes mellitus may help to target interventions for better glycemic control," they concluded. (Okura T, et al. J Am Geriatr Soc 2009;57:1816-1824.)

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