title: Glycemic control, cognitive function, and family support among middle-aged and older Hispanics with diabetes: The Hispanic Community Health Study/Study of Latinos.
abstract: OBJECTIVE
  To examine among Hispanics in the U.S., a population with increased reliance on informal healthcare support structures, (1) the association between cognitive function and control of diabetes; and (2) whether this association is modified by family support.
  
  
  METHODS
  The Digit Symbol Substitution Test (DSST), word fluency, and learning and delayed recall components of the Spanish English Verbal Learning Test were administered to 1794 Hispanic adults aged 45-76years with diagnosed diabetes. An executive function index and global cognitive function index (GCFI) were derived. Uncontrolled diabetes (HbA1c⩾7% [53mmol/mol]) was compared across quartiles of cognitive function using multivariable logit models with interaction terms for cognitive function and family support.
  
  
  RESULTS
  After adjustment, lower DSST scores were associated with uncontrolled diabetes (P=0.03). Family support modified the relationship between other measures of cognition and diabetes control (Pinteraction: 0.002, 0.09). Among individuals with low family support, as cognitive function declined, the odds of uncontrolled diabetes increased (P-trend across quartiles of the GCFI, 0.015). Among those with low family support, persons in the lowest quartile of global cognitive function were more than twice as likely to have uncontrolled diabetes as those in the highest performing quartile (OR=2.31; 95% CI: 1.17, 4.55). There was no similar effect among those with high family support.
  
  
  CONCLUSIONS
  Family support may buffer the negative association between low cognitive functioning and diabetes control in US Hispanics/Latinos. Educational programs targeted at family members of middle-age and older persons with diabetes regardless of neurocognitive status may help improve population-level glycemic control.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, United States. Electronic address: gstrizich@gmail.com.
authors.forename: Garrett
authors.initials: G
authors.lastname: Strizich
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, United States.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, East Lansing, MI 48824, United States.
authors.forename: Hector M
authors.initials: HM
authors.lastname: González
authors.affiliation: Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk Street, Chicago, IL 60612, United States.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.
authors.forename: Aida L
authors.initials: AL
authors.lastname: Giachello
authors.affiliation: Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 137 East Franklin Street, Chapel Hill, NC 27514, United States.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Teng
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, United States; The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Room 316, Bronx, NY 10461, United States; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, United States.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.affiliation: The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Kennedy Center Room 316, Bronx, NY 10461, United States.
authors.forename: Ellen
authors.initials: E
authors.lastname: Grober
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology*; D003376:Counseling; D003920:Diabetes Mellitus / Q000208:ethnology / Q000503:physiopathology* / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D007003:Hypoglycemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000517:prevention & control; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: Cognitive function; Diabetes; Glycemic control; Hispanic; Social support