Type 2 Diabetes and Cognitive Impairment: Prevalence in an Outpatient Clinic and Opportunities for Improvement in Quality Use of Medicines

Abstract

There is an association between diabetes and cognitive impairment which may impact diabetes self-care and outcomes both in the community and in hospital. Screening of older people with diabetes for cognitive impairment has been recommended to identify need for additional support and to minimise potential risks, but this is not routine practice in Australia. The primary aim of this thesis is to contribute to addressing this gap by assessing cognitive function in older people living with type 2 diabetes attending an ambulatory care diabetes clinic at a tertiary referral hospital to identify the scope of the issue locally. The Montreal Cognitive Assessment and Problem Areas in Diabetes questionnaires (Appendices 1 and 2) were completed, n=50. The key finding was that 36/50 (72%) patients were identified with a MoCA score <26, with a mean score in this group of 22.6 (SD 2.3). The secondary aim was to identify potential adverse medication impact associated with cognitive impairment in diabetes. A retrospective review of 100 inpatients prescribed a sulphonylurea was conducted to identify episodes of hypoglycaemia. Documented cognitive impairment was more prevalent in the 34 patients identified to have experienced hypoglycaemia (RR 1.64, 95% CI 0.77-3.5). This thesis identifies the local feasibility and potential significance of cognitive screening in people with type 2 diabetes. This informs future practice to embed cognitive screening to prioritise people who may benefit from focused review of medication. This may minimise risk of medication adverse effects, in the community as well as on admission to hospital, and potentially optimise management of both diabetes and cognitive impairment.