Implications of cognitive and daily living capabilities on early type 2 diabetes management: a preliminary case-control study

Abstract

Background: Adherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40-74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country.

Methods: A case-control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson's r.

Results: The primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0-0.26). In linear regression analysis among MoCA-B and IADL scores, "delayed recall" and "orientation" domains from MoCA-B, and "managing medications" and "using the phone" from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B's "orientation" with IADL's "using the phone" and "managing medications" (p-values < 0.0001).

Conclusion: Superior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients' instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.

Keywords: Dementia; Diabetes mellitus; Instrumental activities of daily living; Montreal cognitive assessment; Treatment adherence.

Fig. 1

Inter-battery correlations of MoCA and IADL domains illustrated as a heatmap. Colors demonstrate the extent of correlation according to the color bar. p-values are written within each cell and asterisks refer to the level of significance. ****< 0.0001; ***< 0.001; **< 0.01; *< 0.05

Fig. 2

Intra-battery correlations of MoCA and IADL domains illustrated in two half-heatmaps. Colors demonstrate the extent of correlation according to the color bar. The diagonal red cells represent the correlations of identical domains. p-values are written within each cell and asterisks refer to the level of significance. ****< 0.0001; ***< 0.001; **< 0.01; *< 0.05