TABLE 2.

Role of Health Care Professionals in Supporting the Needs of People With Diabetes and Cognitive Impairment

Health Care ProfessionalsServices
Diabetes medical providers1. Screen patients for cognitive impairment, determine etiology of cognitive decline, and/or refer to a specialty provider (neurologist or neuropsychologist) for further evaluation and provide for treatment of cognitive impairments, as indicated; screening might include using the Montreal Cognitive Assessment, asking patients about cognitive changes, and asking family about cognitive changes
2. Make appropriate referrals for ongoing diabetes care management to a:
 a. Nurse for home care needs such as medication management, glucose monitoring or wound care
 b. Dietitian for nutritional needs
 c. Physical therapist to address mobility and balance issues
 d. Occupational therapist to address home safety needs
 e. Diabetes educators to address educational needs of the patient, family, and other caregivers
 f. Podiatrist for foot care
 g. Mental health provider or social worker to address psychosocial needs
 h. Pharmacist for coordination of medication needs and refill management
 i. Specialty care provider (e.g., cardiologist, neurologist, optometrist, ophthalmologist, dentist, nephrologist, or endocrinologist), as needed
3. Foster a collaborative relationship among patients, their family members, and other members of the health care team
4. Seek opportunities to simplify regimens
5. Adjust medical regimens to minimize hypoglycemia and symptomatic hyperglycemia
Registered nurses1. Discuss with patients (and families) their concerns and preferences in relation to their diabetes and move to incorporate nursing care to meet these, as appropriate
2. Help patients (and/or their caregivers) who perform SMBG to interpret results and encourage autonomous decision-making where possible
3. Provide instructions in simplified terms
4. Obtain assistive devices such as an automatic pill dispenser, as needed
Registered dietitians1. Ascertain and maintain patients’ nutritional needs and food preferences
2. Review nutrition, establishing realistic carbohydrate, protein, and caloric goals
3. Provide realistic meal plans
4. Refer to outside agencies as needed (e.g., Meals on Wheels)
Physical therapists, occupational therapists, and speech therapists1. Assess patients’ functional abilities and limitations
2. Establish a safe activity regimen
3. Establish a safe home environment
4. Recommend assistive devices as needed
Certified diabetes educators or other diabetes educators1. Educate patients, families, caregivers, and staff how to best manage diabetes and meet diabetes-related needs, including prevention, recognition, and treatment of hypoglycemia
2. Provide behavioral, educational, psychosocial, and clinical support
3. Recommend assistive devices as needed (e.g., use of syringe magnifiers or change from use of insulin syringes to insulin pens)
Mental health providers and social workers1. Assess patients’ mental health status and needs
2. Provide emotional and behavioral therapies, as needed
3. Refer as needed to ensure patients receive appropriate care and ongoing support
Neuropsychologists1. Determine whether patients’ cognitive impairment is of sufficient severity to affect diabetes self-management tasks
2. Provide recommendations for strategies to mitigate the impact of cognitive impairment on diabetes tasks
3. Support and educate family members on the nature of cognitive impairment and how they can support the patient
4. Make targeted recommendations for cognitive rehabilitation
5. Consult with other members of the medical team regarding best practices given a patient’s specific profile of cognitive strengths and weaknesses (e.g., suggest a simplified treatment regimen, suggest written versus oral communication, or indicate the need for caregiver support in medical management)