As the number of older adults in the U.S. increases, the population of older adults living with co-existing Type 2 diabetes and dementia is increasing. These older adults are at risk for poor self-management of medications for diabetes, poor glycemic control, and subsequent serious complications. As such, this little- studied subpopulation of those living with diabetes constitutes a growing public health concern. Among older adults, diabetes mellitus is one of the few causes of death that is increasing in frequency, with the death rate for Type 2 diabetes increasing 45% since 1987. With increasing frequency of obesity and sedentary lifestyles in the U.S. population, diabetes will become more prevalent, especially among older adults. The purpose of this study is to determine if diabetes educational materials designed for persons with early dementia, coupled with a cognitive intervention (Space Retrieval - SR), improve self-management of medications and blood glucose monitoring and subsequent glycemic control for older adults living with both Type 2 diabetes and dementia. Objectives of the study are as follows: (1) To determine the extent to which strategies developed to improve self-management behaviors related to medications and blood glucose monitoring for older adults with Type 2 diabetes and early stage dementia can be learned, and under what conditions, using netbooks for intervention. (2) To determine whether such strategies, once learned, can be implemented successfully;and, (3) To examine the relationship between strategy learning and implementation and changes in both psychological and physiological outcomes associated with successful glycemic control. Forty-eight older adults with Type 2 diabetes and early dementia, taking oral diabetic medications only, will be randomly assigned to either a Standard Education or Standard Education + SR group. Standard Education sessions for self-management of diabetes will be delivered via netbooks with Skype by Certified Diabetes Educators. Effects produced by this condition will be compared with those produced by a Standard Education + SR condition. Both groups will participate in two Initial Education sessions designed to improve medication-taking and blood glucose monitoring through the development of two individualized self-monitoring strategies. Both groups will then participate in 8 Additional Education sessions, focused on diet self-management. The SR group will receive this education with embedded SR treatment designed to enhance retention and implementation of the original two individualized self- monitoring strategies. Primary outcome measures, compared between groups, and measured at 1, 3, and 6-months post-intervention include strategy learning and strategy implementation. Additional outcomes include mood state and perceived self-efficacy for managing diabetes. Satisfaction with the use of netbooks, and HgA1c and serum cholesterol panels, will be assessed at final posttest. Cost analyses and health care utilization measures will be developed, as well, to assist in future translation efforts.

Public Health Relevance

The number of older adults living with both Type 2 diabetes and dementia is expected to continue increasing rapidly. This little-studied subpopulation will constitute a significant public health concern for the future. These older adults, especially those living independently with early stage dementia, are at risk for poor self-management of diabetes and subsequent serious complications. The purpose of this study is to develop diabetes educational materials that work effectively with this demographic and to test whether these materials, coupled with a cognitive intervention called Spaced Retrieval, will improve diabetes self- management and clinical outcomes.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Planning Grant (R34)
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Special Emphasis Panel (ZDK1-GRB-1 (J1))
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Hunter, Christine
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Linda and Cameron, Inc.
United States
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