Subacute Service, Queen Elizabeth Centre, Ballarat Health Services, Ballarat Central, Australia.
Department of Forensic Medicine, Monash University, Melbourne, Australia.
Diabetes Metab Res Rev. 2018 Sep;34(6):e3013. doi: 10.1002/dmrr.3013. Epub 2018 Jun 5.
Self-management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self-care. The aims of this study are to know (1) whether CogImp associated with dementia impact self-care and (2) whether specific CogImp affects key DM self-care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self-care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self-care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49-1.55), resulting in poorer glycemic control. Decision-making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02-1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85-0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96-0.97), and LDL-C testing (ARR = 0.91, 95% CI = 0.901-0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30-3.70). Action taking deficits were apparent through less self-testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self-care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self-care tasks.
自我管理是慢性病管理的重要组成部分。与痴呆相关的认知障碍（CogImp）以前并未在糖尿病（DM）自我护理中进行过综述。本研究的目的是了解（1）与痴呆相关的 CogImp 是否会影响自我护理，以及（2）是否特定的 CogImp 会影响 DM 自我护理的关键过程。根据系统评价和荟萃分析的首选报告项目进行了系统文献检索和叙述性综述。本综述检查了 2000 年 1 月至 2016 年 2 月期间描述认知与社区居住的痴呆/认知障碍老年人的 DM 自我护理领域之间关系的研究。八项研究符合纳入标准。所有自我护理领域的认知能力下降均与 CogImp 有关。解决问题与疾病知识减少有关（OR 0.87，95％CI = 0.49-1.55），导致血糖控制不佳。决策障碍表现为难以调整胰岛素剂量，导致更多的住院治疗。没有认知障碍的人更能够通过坚持建议的治疗来寻找/利用资源（OR 1.03，95％CI = 1.02-1.05）。与医疗保健提供者的互动减少表现为减少了接受重要常规检查，包括眼科检查（ARR = 0.85，95％CI = 0.85-0.86），HbA1c 测试（ARR = 0.96，95％CI = 0.96-0.97）和 LDL-C 测试（ARR = 0.91，95％CI = 0.901-0.914）。没有认知障碍的人就诊率更高（OR 2.17，95％CI = 1.30-3.70）。通过较少的自我血糖测试（20.2％与 24.4％，P = 0.1）来减少行动缺陷，导致血糖控制不佳，自我护理以及更频繁的微血管/大血管并发症。患有糖尿病和认知障碍的人，尤其是在学习，记忆和执行功能领域，在所有自我护理任务中都受到严重影响。
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