Cognitive function and self-care in type 2 diabetes

The extent to which diabetes is associated with cognitive dysfunction is a very topical issue (Strachan et al, 2008). Longitudinal and cross-sectional studies have provided concrete evidence that the risk of cognitive dysfunction increases as duration and complications of diabetes increase (Gregg et al, 2000; Fontbonne et al, 2001; Areosa and Grimley, 2002; Cukierman et al, 2005; Kumari and Marmot, 2005). Although physiological and metabolic parameters behind cognitive dysfunction are interesting in themselves (Stolk et al, 1997; Kumari et al, 2000; Grodstein et al, 2001; Knopman et al, 2001; Hassing et al, 2004; Gallacher et al, 2005), what is particularly relevant in terms of helping people self-manage their condition is the extent to which cognitive dysfunction in diabetes is associated with poor self-care behaviours. If cognitive dysfunction is associated with a decline in ability to self-care, clinicians might find knowing about this relationship useful in planning their consultations and offering additional support to people who may be at risk. This paper reviews current literature on the relationship between cognitive function and self-care and concludes with a practical guide on how to assess both of these in the primary care setting.