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Review
. 2024 Jun 12:17:2403-2417.
doi: 10.2147/DMSO.S410363. eCollection 2024.

Barriers and Facilitators of Self-Management in Older People with Type 1 Diabetes: A Narrative Review Focusing on Cognitive Impairment

Luciana Mascarenhas Fonseca #  1   2 , Juliana Janeiro Schmidt #  3 , Frank J Snoek  4 , Ruth S Weinstock  5 , Naomi Chaytor  1 , Heather Stuckey  6 , Christopher M Ryan  7 , Eelco van Duinkerken  3   4
Affiliations
Review

Barriers and Facilitators of Self-Management in Older People with Type 1 Diabetes: A Narrative Review Focusing on Cognitive Impairment

Luciana Mascarenhas Fonseca et al. Diabetes Metab Syndr Obes. .

Abstract

Over the past decades, life expectancy of people with type 1 diabetes has increased considerably, which brings potential challenges due to the process of aging. Cognitive aging and dementia, as well as reductions in visual acuity, hearing and dexterity, can influence the frequency and quality of daily self-management activities, including medication taking and insulin dosing, glucose self-monitoring, and healthy eating. This can increase the risk for hypo- and hyperglycemic events, which, in turn, may contribute to cognitive decline. Because there is a gap in understanding the barriers and facilitators of self-management in older adults with type 1 diabetes and the relationship to cognitive functioning, the authors 1) review the available literature on cognitive aging and type 1 diabetes, 2) describe what self-management in later adulthood entails and the cognitive functions required for effective self-management behaviors, 3) analyze the interaction between type 1 diabetes, cognition, aging, and self-management behaviors, and 4) describe the barriers and facilitators for self-management throughout the life span and how they may differ for older people. Potential evidence-based practices that could be developed for older adults with type 1 diabetes are discussed. There is need for further studies that clarify the impact of aging on T1D self-management, ultimately to improve diabetes care and quality of life.

Keywords: aging; cognition; self-management; type 1 diabetes.

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Conflict of interest statement

FS reports personal fees/grants from Eli Lilly, Sanofi, Abbott, and Roche Diabetes, outside the submitted work. RSW reports participation in multicenter clinical trials, through her institution, sponsored by Insulet, Tandem, Eli Lilly, MannKind, Amgen, Diasome, and DexCom provided devices at reduced cost. NC reports personal fees from Adaptelligence, LLC, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
A schematic overview of factors related to cognitive impairment in older people with T1D. On top are factors that have been found to be related to cognitive impairment. In the middle, some factors have been added which can be considered a consequence of T1D and may play a mediating role in these factors relating to cognitive impairment.
Figure 2
Figure 2
A schematic overview of the core competencies for type 1 diabetes self-management, where coping, reducing risk, problem solving, and monitoring were placed at the center. Competencies, including healthy eating, taking medication, and physical activity, in part are dependent on the other competencies.
Figure 3
Figure 3
Cycle model of self-management, cognition, and aging in type 1 diabetes. There is a bidirectional relationship between self-management and cognition in T1D: cognitive performance influences the quality of diabetes management, and suboptimal diabetes management may also increase the likelihood of worsening cognitive performance. Both the presence of T1D and aging will affect this relationship between cognition and self-management, enhancing the dependence and strength of this bidirectional association: cognitive difficulties associated with T1D negatively impact the self-management needs generated by the disease; with age-related decline, self-management ability deteriorates and the need for planned self-management increases considerably.
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