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Does Computerized Cognitive Training Improve Diabetes Self-Management and Cognition? A Randomized Control Trial of Middle-Aged and Older Veterans with Type 2 Diabetes

  • Jeremy M. Silverman
    Correspondence
    Corresponding author at: Jeremy M. Silverman, Research & Development, Code 151, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, x1700
    Affiliations
    Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA

    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Carolyn W. Zhu
    Affiliations
    Brookdale Department of Geriatrics & Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
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  • James Schmeidler
    Affiliations
    Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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  • Pearl G. Lee
    Affiliations
    Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA

    Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
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  • Neil B. Alexander
    Affiliations
    Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA

    Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA
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  • Elizabeth Guerrero-Berroa
    Affiliations
    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Department of Psychology, Lehman College, City University of New York, Bronx, NY, USA
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  • Michal S. Beeri
    Affiliations
    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
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  • Rebecca K. West
    Affiliations
    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Mary Sano
    Affiliations
    Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA

    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Martina Nabozny
    Affiliations
    Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA

    Department of Internal Medicine and Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
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  • Martha Karran
    Affiliations
    Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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Published:November 21, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110149

      Highlights

      • Type 2 diabetes (T2D) is a risk factor for cognitive decline.
      • Cognitive decline, in turn, contributes to poor diabetes self-management.
      • Computerized cognitive training (CCT) aims to enhance/maintain cognitive function.
      • While adaptive CCT did not outperform non-adaptive CCT, both improved self-management.
      • Combined CCT groups had many cognitive and T2D-related improvements 6 months later.

      Abstract

      1. Aims. This randomized control trial compared an adaptive computerized cognitive training intervention with a non-adaptive version. The primary hypothesis predicted better diabetes self-management in type 2 diabetes patients at 6 months post-intervention than baseline, with seven secondary outcomes.
      2. Methods. Intent-to-treat analysis of veterans without dementia aged 55+ from the Bronx, NY and Ann Arbor, MI (N=90/per arm) used linear mixed model analyses.
      3. Results. Contrary to the hypothesis, only memory showed more improvement in the adaptive arm (p<0.01). Post-hoc analyses combined the two arms; self-management improved at six-months post-intervention (p<0.001). Memory, executive functions/attention, prospective memory, diastolic blood pressure, and systolic blood pressure improved (p < 0.05); hemoglobin A1c and medication adherence did not improve significantly.
      4. Conclusions. The adaptive computerized cognitive training was not substantially better than non-adaptive, but may improve memory. Post-hoc results for the combined arms suggest computer-related activities may improve diabetes self-management and other outcomes for middle-aged and older patients with type 2 diabetes. Practice effects or awareness of being studied cannot be ruled out.

      Keywords

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