Type 2 diabetes mellitus, cognition and self-management behavior in Mexican American older adults

Mexican Americans carry a much heavier disease burden of type two diabetes mellitus (T2DM) than non-Hispanic Whites. Effective self-management behaviors are critical in reducing this burden and the resulting morbidity and mortality from T2DM. The purpose of this correlational study was to investigate the relationship between T2DM level of control (HbA1c), T2DM duration, cognitive function, and self-management behavior in MA older adults. A unique contribution to this study was the examination of the impact of depression on these factors. The Self-Care of Chronic Illness Theory was used to undergird and guide the research. The study was a secondary analysis from a prior epidemiological study that used correlations and regressions to examine the relationships between the variables. The Summary of Diabetes Self-Care Activities Questionnaire was used to measure self-management behavior. Cognitive function was measured using neuropsychological tests including The Trail Making Test Parts A and B, Wechsler Memory Scale 3rd subtests Logical Memory I, II and Digit Span, and the Controlled Word Association Test. Depression was measured using the Geriatric Depression Scale. Participants (n =141) who met the inclusion criteria (aged 50 and over, MA, diagnosed with T2DM, and cognitively unimpaired classification) were selected. Depression was significantly correlated with immediate working memory, language and general diet with p-values ranging from .001-.036. All regression models using level of control, T2DM duration, depression, and cognitive function to predict general diet were significant (p <.022) at the model level. Among the independent variables in the models depression was the only significant independent variable (p = .003-.004). Depression was a critical factor in negatively impacting self-management behavior. Thus, it is extremely important for nurses to address depression and depressive symptoms when working with patients to facilitate self-management behaviors. In addition to addressing depression, T2DM self-management behavior education requires both nursing and neuropsychology to translate the complex nature of cognitive function into a T2DM self-management behavior.