CC BY-NC-ND 4.0 · Journal of Social Health and Diabetes 2020; 8(01): 008-012
DOI: 10.1055/s-0040-1719223
Original Article

An Exploratory Study of Cognitive Functioning and Psychological Well-Being in Middle-Aged Adults with Diabetes Mellitus

Susmita Halder
1   Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India
Shinjini Samajdar
1   Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India
Akash Kumar Mahato
1   Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India
› Author Affiliations


Background Diabetes mellitus is a chronic metabolic disorder characterized by increased level of blood sugar for a prolonged period of time. Apart from its impact on the bodily functions, the disorder has its own psychological consequences, commonly in terms of stress reaction, anxiety, and depression. Diabetes is also known to affect cognitive functions, but it is less studied in the Indian population and relatively ignored in the management plan. Discerning the cognitive functions in middle-aged adults diagnosed with diabetes can give valuable insight into comprehensive management of the disorder. With this background, the study attempted to explore the cognitive functioning and psychological well-being of middle-aged adults with diabetes and compared with healthy individuals.

Methods A total of 30 middle-aged adults of both sexes diagnosed with diabetes type 2 were undertaken for the study and compared with 30 healthy adults regarding measures of cognitive functioning and psychological well-being. The measures were also explored for relationship if any with illness duration.

Results Middle-aged adults with diabetes differed significantly in terms of response inhibition and processing speed compared with healthy controls. The groups significantly differed on subjective Psychological well-being in terms of self-control, anxiety and depression, and vitality. Duration of illness was found to be related to anxiety symptoms.

Conclusion Diabetes affects response inhibition and processing speed in middle-aged adults. Assessing and addressing impairment in cognitive functions is recommended for a comprehensive management of diabetes in middle-aged adults.

Publication History

Article published online:
24 November 2020

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  • References

  • 1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (Suppl. 01) S62-S67
  • 2 Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale. Diabetes Care 2000; 23 (09) 1305-1309
  • 3 Shepard JA, Vajda K, Nyer M, Clarke W, Gonder-Frederick L. Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes. J Pediatr Psychol 2014; 39 (10) 1115-1125
  • 4 Cemeroglu AP, Can A, Davis AT. et al. Fear of needles in children with T1D mellitus on multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII). Endocr Pract 2015; 21: 46-53
  • 5 Balhara YP. Diabetes and psychiatric disorders. Indian J Endocrinol Metab 2011; 15 (04) 274-283
  • 6 Moheet A, Mangia S, Seaquist ER. Impact of diabetes on cognitive function and brain structure. Ann N Y Acad Sci 2015; 1353: 60-71
  • 7 Ohmann S, Popow C, Rami B. et al. Cognitive functions and glycemic control in children and adolescents with type 1 diabetes. Psychol Med 2010; 40 (01) 95-103
  • 8 Li W, Huang E, Gao S. Type 1 diabetes mellitus and cognitive impairments: a systematic review. J Alzheimers Dis 2017; 57 (01) 29-36
  • 9 Tonoli C, Heyman E, Roelands B. et al. Type 1 diabetes-associated cognitive decline: a meta-analysis and update of the current literature. J Diabetes 2014; 6 (06) 499-513
  • 10 Gregg EW, Yaffe K, Cauley JA. et al. Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 2000; 160 (02) 174-180
  • 11 Munshi M, Grande L, Hayes M. et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care 2006; 29 (08) 1794-1799
  • 12 Fontbonne A, Berr C, Ducimetière P, Alpérovitch A. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 2001; 24 (02) 366-370
  • 13 Hamed SA, Youssef A, Elserogy Y. et al. Cognitive function in patients with type 2 diabetes mellitus: relationship to stress hormone (cortisol). J Neurol Neurosci 2013; 4: 3
  • 14 Hazari MAH, Reddy BR, Uzma N, Kumar BS. Cognitive impairment in type 2 diabetes mellitus. Int J Diabetes Mellit 2015; 3 (01) 19-24
  • 15 Kalar MU, Mujeeb E, Pervez S. et al. Assessment of cognitive status in type 2 diabetes. Int J Collab Res Intern Med Public Health 2014; 6 (08) 235
  • 16 Halder S, Mahato AK. Cognition in ageing: implications for assessment and intervention. In: Handbook of Research on Geriatric Health, Treatment, and Care. Hershey, PA: IGI Global; 2018: 118-133
  • 17 Rao SL, Subbakrishna DK, Gopukumar K. NIMHANS Neuropsychological Battery-Manual. Bangalore, India: National Institute of Mental Health and Neurosciences; 2004
  • 18 Lezak MD. Trail making test. In: Neuropsychological Assessment. 3rd ed. New York, NY: Oxford University Press; 1995
  • 19 Trenerry MR, Crosson B, DeBoe J, Leber WR. Stroop Neuropsychological Screening Test Manual. Lutz, FL: Psychological Assessment Resources; 1989
  • 20 Dupuy HJ. The Psychological General Well-Being Index (PGWB). Available at:
  • 21 Anjana RM, Pradeepa R, Deepa M. et al. ICMR-INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011; 54 (12) 3022-3027
  • 22 Ishizawa KT, Kumano H, Sato A, Sakura H, Iwamoto Y. Decreased response inhibition in middle-aged male patients with type 2 diabetes. Biopsychosoc Med 2010; 4 (01) 1
  • 23 Yun HS, Kim MA, Kim MH, Suh SR, Kim H. Evaluation of visual-motor integration in elderly patient with diabetes mellitus. Hanguk Nonyonhak 2011; 31: 641-652
  • 24 Dik MG, Jonker C, Comijs HC. et al. Contribution of metabolic syndrome components to cognition in older individuals. Diabetes Care 2007; 30 (10) 2655-2660
  • 25 Okereke OI, Kang JH, Cook NR. et al. Type 2 diabetes mellitus and cognitive decline in two large cohorts of community-dwelling older adults. J Am Geriatr Soc 2008; 56 (06) 1028-1036
  • 26 Ruis C, Biessels GJ, Gorter KJ. van den Donk M, Kappelle LJ, Rutten GE. Cognition in the early stage of type 2 diabetes. Diabetes Care 2009; 32 (07) 1261-1265
  • 27 Spauwen PJJ, Köhler S, Verhey FRJ, Stehouwer CDA, van Boxtel MPJ. Effects of type 2 diabetes on 12-year cognitive change: results from the Maastricht Aging Study. Diabetes Care 2013; 36 (06) 1554-1561
  • 28 Berlin I, Bisserbe JC, Eiber R. et al. Phobic symptoms, particularly the fear of blood and injury, are associated with poor glycemic control in type I diabetic adults. Diabetes Care 1997; 20 (02) 176-178
  • 29 Holt RI, de Groot M, Golden SH. Diabetes and depression. Curr Diab Rep 2014; 14 (06) 491
  • 30 Ryff CD, Dienberg Love G, Urry HL. et al. Psychological well-being and ill-being: do they have distinct or mirrored biological correlates?. Psychother Psychosom 2006; 75 (02) 85-95
  • 31 Sommerfield AJ, Deary IJ, McAulay V, Frier BM. Short-term, delayed, and working memory are impaired during hypoglycemia in individuals with type 1 diabetes. Diabetes Care 2003; 26 (02) 390-396
  • 32 Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci 2011; 13 (01) 7-23