Impact of a community-based diabetes self-management support program on adult self-care behaviors.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; P-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.

Longitudinal changes in cognition in early Parkinson's disease patients with REM sleep behavior disorder.

INTRODUCTION: Cognitive decline is common in Parkinson's disease (PD), and identifying patients at highest risk for it is essential. We aimed to examine the effect of possible REM sleep behavior disorder (pRBD) on rate of cognitive decline in early PD, for both global cognition and in specific cognitive domains. METHODS: Parkinson's Progression Markers Initiative (PPMI) is a multi-site, international study of PD patients untreated at enrollment. pRBD was assessed with the REM sleep behavior disorder questionnaire (RBDSQ). Global cognition was assessed at baseline and annually using the Montreal Cognitive Assessment (MoCA) and a cognitive battery. Linear mixed effects models were used to examine the relationship between pRBD (RBDSQ≥6) and rate of change in cognitive variables. Age, sex, years of education, and baseline motor and cognitive scores were included as covariates. RESULTS: The baseline sample consisted of 423 individuals with PD, mean age 61.7 years and 65.5% male. Data was available on 389, 366, and 196 participants at 1-year, 2-year, and 3-year follow-up respectively. Possible RBD occurred in 108 (25.5%) at baseline. In multivariate analyses, baseline RBD was associated with greater annual rate of decline in MoCA score (ß = -0.34, 95%CI -0.54, -0.13, p < 0.001), Symbol Digit Modalities Test (ß = -0.69, 95%CI -1.3, -0.09, p = 0.024), and Hopkins Verbal Learning Test-Revised, delayed free recall (ß = -0.21, 95%CI -0.41, -0.013, p = 0.037). CONCLUSIONS: Possible RBD is common in early PD and predicts future cognitive decline, particularly in attention and memory domains.