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cognitive function, executive function, older adult, self-management, type 2 diabetes



  1. Kim, Min Jung
  2. Bronas, Ulf G.
  3. Quinn, Laurie
  4. Sharp, Lisa K.
  5. Park, Chang
  6. Gruss, Valerie
  7. Fritschi, Cynthia


Background: Type 2 diabetes (T2D) is strongly associated with cognitive impairment. Decreased cognitive function could affect daily self-management behaviors critical for people with T2D. Executive function is significant for daily self-management, and decreased subjective cognitive function could be an early indicator of poor daily self-management. However, little is known about whether executive or subjective cognitive function affects daily self-management behaviors in older adults.


Objectives: We investigated the effect of executive function or subjective cognitive function on daily self-management behaviors (diet, glucose management, physical activity, and physician contact) in older adults with T2D.


Methods: We used a cross-sectional, observational design with convenience sampling of 84 adults aged >=60 years with T2D. Telephone-administered cognitive function tests measured participants' overall cognitive and executive function levels. Subjective cognitive function, diabetes self-management, and covariates, including demographic information (age, gender, race/ethnicity, and level of education), body mass index, depressive symptoms, and diabetes duration, were assessed using online surveys. Data were analyzed using bivariate correlation and backward stepwise regression.


Results: The mean age of the sample was 68.46 +/- 5.41 years. Participants were predominantly female and White, and the majority had normal cognitive function. Controlling for demographics, body mass index, depressive symptoms, and diabetes duration, a decrease in executive function indicated by a greater number of errors made during the telephone-administered Oral Trail Making Test Part B relative to the sample was associated with poorer adherence to physician contact behaviors. Subjective cognitive function was not associated with any self-management behaviors.


Discussion: A reduction in executive function was associated with poorer adherence to physician contact behaviors in older adults with T2D and normal cognitive function; lack of adherence to physician contact behaviors could be an early indicator of declining cognitive function. Difficulties or changes in routine diabetes self-management behaviors should be closely monitored in older adults. Cognitive assessment should be followed when needed.