The Interplay of Diabetes, and Health Self Efficacy, Cognition and Compliance
Globesity has partially been responsible for an outbreak of diabetes which affects 340 million people in the world today1. Severe diabetes, which would have killed a patient fifty years ago, can now be managed for decades longer. So the number of diabetics is increasing both among the obese young and the elderly who live longer. Amongst diabetic adults, the cardiovascular disease (CVD) death rate has declined by 40% (95% CI 23–54), while the death rate from all other causes declined by 23% over a ten year period from 1997 to 2006. Not surprisingly therefore, the rate of diabetes and the concomitant disorders continues to grow. Diabetes can also lead to significant cognitive decline which leads to interference with compliance, socialization and quality of life. Diabetes causes an increase in cognitive impairment in vascular dementia. Type 2 Diabetes may act as a partial causal agent of some dementias, and the link between diabetes and Alzheimer’s has led a number of researchers to claim Alzheimer’s is in reality a Type 3 diabetes. A clear and statistically significant relationship exists between HbA1c levels and the duration of diabetes mellitus and cognitive dysfunction. While the causal mechanism remains unknown Type 2 Diabetes clearly causes cognitive impairment. This genetic predisposition to diabetes may be greatest amongst South Asian Indians, and Hispanics. While genetics is certainly not the sole determinant of diabetes, genetics likely plays a key role. Some type of brief cognitive screening battery needs to be developed to screen for Mild Cognitive Impairment, and Health Self Efficacy, both of which affect compiance. This information could be used to make treatment decisions, both in terms of compliance and in terms of recommendations which may affect an individual’s Quality of Life. With cognitive impairment and low Health Self Efficacy due to diabetes, screening can be a key tool in evaluating educational techniques which would aid patients, their communities and their families as to the type of interventions which may prove useful.