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We identify three patterns of strategy maintenance that emerged from follow-up interviews with 19 participants: sustained use, partial use, and discontinuation. Factors that supported long-term use of strategies include consistent routines, social support, and personal value placed on cognitive improvements. Barriers include inconsistent routines, lack of support, and negative emotions such as guilt. This study emphasizes the need for personalized, adaptable cognitive interventions and ongoing support to promote lasting benefits in both cognitive function and diabetes self-care.<\/jats:p>","DOI":"10.1371\/journal.pone.0349848","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:39:31Z","timestamp":1791221971000},"page":"e0349848","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maintaining cognitive gains in type 2 diabetes: Barriers, supports, and patterns of strategy use"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4314-6686","authenticated-orcid":true,"given":"Heather E.","family":"Cuevas","sequence":"first","affiliation":[{"name":"The University of Texas at Austin","place":["Austin, Texas, United States of America"],"department":["The School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7913-4463","authenticated-orcid":true,"given":"Jeeyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"The University of Michigan","place":["Ann Arbor, Michigan, United States of America"],"department":["Department of Physical Medicine and Rehabilitation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenell T.","family":"Wood","sequence":"additional","affiliation":[{"name":"Victoria College","place":["Victoria, Texas, United States of America"],"department":["Division of Allied Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"pone.0349848.ref001","unstructured":"Centers for Disease Control and Prevention. 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