Educating CDEs to Screen for Impaired Cognition in Elderly Individuals with Type 2 Diabetes Mellitus

There is a growing population of older Americans with diabetes at increased risk for cognitive impairment, however this risk is poorly disseminated among providers of diabetes care. The purpose of this project was to research and disseminate the state of the science regarding the increased risk for impaired cognition in older adults with type 2 diabetes mellitus (T2DM) and to recommend a validated cognitive screening tool. The objectives of this project were to create an educational module targeting diabetes educators, to present this module at a conference of diabetes educators, and to disseminate the information to a broader diabetes education audience. In 2010, the Centers for Disease Control and Prevention estimated more than a quarter of the adult population age 65 and older had diabetes. There were a million new diagnoses in the 45-64 age group, inferring a tidal wave of individuals who will be aging with the disease and its complications. Incidentally, between 2001 and 2009 there were 3.4 million new cases of dementia and 4.8 million people developed diagnosable cognitive impairment. The prevalence is expected to double every 20 years. While most diabetes care is provided by primary care providers, there are more than 13,000 Certified Diabetes Educators (CDEs). They consist of primarily registered nurses and dieticians whose scope of practice includes diabetes assessment of patient abilities and barriers, education, teaching and training, and potentially recommending medication changes. A recent practice survey demonstrated that most of CDE visits are with persons who have T2DM and half are age 65 and older. The literature demonstrates that older adults with T2DM have up to more than four times the risk for cognitive impairment above those without diabetes. This risk is associated with duration of disease, glycemic control, and severe hypoglycemic episodes among many theorized etiologies. Because of this multifactorial association, there are no proven prevention options. Not recognizing an impairment can result in worsening cognition, poor disease control, and mortality. The best guidelines encourage safe attention to risk factors and monitoring cognition. Currently CDEs have no standard of practice regarding assessing cognition. The Mini-Cog has shown to be a validated and reliable tool in the elderly diabetic population in an outpatient setting. A twenty minute educational PowerPoint presentation regarding the state of the science of the diabetes-cognition interaction in older adults including screening recommendations appropriate for a CDE audience was created. This was presented at a conference session of the American Association of Diabetes Educators on November 6, 2013. Further dissemination was accomplished through submission of a manuscript to The Diabetes Educator on March 21, 2014. Evidence of completion of all facets were submitted to the project chair and accepted as complete. The interaction of T2DM in older adults and cognition is a recognized chronic complication of diabetes. The outcomes from not identifying impairment can result in morbidity and mortality. CDEs provide services to this target population and can act as key agents for patient safety, positive outcomes, and change in practice by implementing cognitive screening.