The association of mental conditions with blood glucose levels in older adults with diabetes.
OBJECTIVE
People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions can co-occur with diabetes are associated with blood glucose levels.


METHODS
We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C.


RESULTS
Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels.


CONCLUSIONS
Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.
Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA. hnguyen@wakehealth.edu
Ha T
HT
Nguyen
Thomas A
TA
Arcury
Joseph G
JG
Grzywacz
Santiago J
SJ
Saldana
Edward H
EH
Ip
Julienne K
JK
Kirk
Ronny A
RA
Bell
Sara A
SA
Quandt
D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D000375:Aging / Q000097:blood / Q000523:psychology; D001008:Anxiety Disorders / Q000097:blood / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism*; D003071:Cognition / Q000502:physiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000523:psychology; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology / Q000523:psychology*; D056344:Executive Function / Q000502:physiology; D015577:Geriatric Assessment; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
D001786:Blood Glucose; D006442:Glycated Hemoglobin