August 11, 2006

Poor diabetes control tied to cognitive difficulty

NEW YORK (Reuters Health) - Elderly diabetics with poor
blood sugar control have a high prevalence of undiagnosed
cognitive dysfunction, depression and functional disabilities,
according to a study by researchers in Boston.

Dr. Medha Munshi, of the Joslin Diabetes Center, and
colleagues examined the association between cognitive
dysfunction and blood sugar control in 60 diabetics older than
age 70. These individuals had diabetes for an average of about
14 years and elevated hemoglobin A1C levels -- an indicator of
poor blood sugar control.

The mean HbA1C level was 7.9 percent. The American Diabetes
Association recommends a target A1C level of 7.0 or lower.

Several common tests were used to screen for cognitive
dysfunction such as the Mini Mental State Examination and
standard drawing tests. The subjects were also screened for
depression and functional disability.

Overall, the Mini Mental State Examination scores
correlated with drawing test scores.

More than a third had low scores on the drawing tests and
these scores were inversely correlated with cognitive function.
This suggests an association between cognitive dysfunction and
poor blood sugar control, the researchers report in Diabetes

The 33 percent of subjects with depressive symptoms also
had greater difficulty completing tasks of daily living.

This population of older diabetics had a high incidence of
functional disabilities. Overall, 48 percent had hearing
impairments, 53 percent had vision impairments, 33 percent had
recently fallen, and 44 percent were afraid of falling.

No association was observed between depression scores and
blood sugar control.

In an interview with Reuters Health, Munshi said: "Elderly
patients with diabetes require special and specific treatment
plans. Elderly patients with diabetes should be screened for
the presence of co-existing medical conditions like cognitive
dysfunction, depression, and physical disabilities as these
conditions may act as barriers to their ability to

Elderly diabetics, she added, may benefit from
"modification of treatment modalities, focused education,
nutrition counseling, and care coordination with the help of a
multidisciplinary team."

SOURCE: Diabetes Care August 2006.