Abstract

Objective: To assess cognitive impairment using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), and to identify associated factors among older adults with diabetes mellitus. The study also evaluated the achievement of glycemic, blood pressure, and lipid targets according to the 2024 American Diabetes Association recommendations.

Methods: A cross-sectional descriptive study with analytical components was conducted among 87 patients aged 65 years or older with diabetes mellitus who were hospitalized at Hue University of Medicine and Pharmacy Hospital from June 2024 to June 2025. Cognitive function was assessed using the Vietnamese versions of the MMSE and MoCA. Metabolic control was categorized according to the 2024 ADA recommendations.

Results: The prevalence of cognitive impairment was 63.2% according to the MMSE and 71.3% according to the MoCA. Multivariable logistic regression identified age ≥75 years, diabetes duration ≥5 years, elevated HbA1c levels, and a history of hypoglycemia as independent factors associated with cognitive impairment. HbA1c showed the best predictive ability for cognitive impairment, with an area under the curve of 0.743 for the MMSE and 0.778 for the MoCA. Only 48.7% of patients achieved the individualized HbA1c target, 46.0% achieved the fasting blood glucose target, 35.6% achieved the bedtime blood glucose target, and 47.1% achieved the blood pressure target. Notably, 4.6% of patients had fasting blood glucose levels and 5.7% had bedtime blood glucose levels below the recommended range; all of these patients had cognitive impairment.

Conclusion: Cognitive impairment is a common complication among older adults with diabetes mellitus. Management should be individualized in accordance with the 2024 ADA recommendations, with particular emphasis on appropriate glycemic control and the prevention of hypoglycemia to preserve cognitive function.