Barriers and Facilitators of Self-Management in Older People with Type 1 Diabetes: A Narrative Review Focusing on Cognitive Impairment

Luciana Mascarenhas Fonseca,1,2,* Juliana Janeiro Schmidt,3,* Frank J Snoek,4 Ruth S Weinstock,5 Naomi Chaytor,1 Heather Stuckey,6 Christopher M Ryan,7 Eelco van Duinkerken3,4 1Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; 2Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil; 3Post-Graduate Program in Neurology, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil; 4Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; 5Department of Medicine, Upstate Medical University, Syracuse, NY, USA; 6Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA; 7Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA*These authors contributed equally to this workCorrespondence: Eelco van Duinkerken, Amsterdam University Medical Centers, Vrije Universiteit, Department of Medical Psychology, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands, Email e.vanduinkerken@amsterdamumc.nlAbstract: Over the past decades, life expectancy of people with type 1 diabetes has increased considerably, which brings potential challenges due to the process of aging. Cognitive aging and dementia, as well as reductions in visual acuity, hearing and dexterity, can influence the frequency and quality of daily self-management activities, including medication taking and insulin dosing, glucose self-monitoring, and healthy eating. This can increase the risk for hypo- and hyperglycemic events, which, in turn, may contribute to cognitive decline. Because there is a gap in understanding the barriers and facilitators of self-management in older adults with type 1 diabetes and the relationship to cognitive functioning, the authors 1) review the available literature on cognitive aging and type 1 diabetes, 2) describe what self-management in later adulthood entails and the cognitive functions required for effective self-management behaviors, 3) analyze the interaction between type 1 diabetes, cognition, aging, and self-management behaviors, and 4) describe the barriers and facilitators for self-management throughout the life span and how they may differ for older people. Potential evidence-based practices that could be developed for older adults with type 1 diabetes are discussed. There is need for further studies that clarify the impact of aging on T1D self-management, ultimately to improve diabetes care and quality of life.Keywords: type 1 diabetes, self-management, cognition, aging