Severe hypoglycemia adversely affects brain health of older people with type 1 diabetes
medwireNews: Severe hypoglycemia may treble the risk for impaired cognitive function in older adults with type 1 diabetes, shows an analysis of data from the Study of Longevity in Diabetes (SOLID).
“Our findings underscore the importance of continued vigilance and management to prevent [severe hypoglycemia] in this older population, as the aging brain may be particularly susceptible to [severe hypoglycemia]-related cognitive decline,” write Mary Lacy (University of Kentucky, Lexington, USA) and co-authors in Diabetes Care.
Lacy and team found that just under a third (32%) of 718 SOLID participants (mean age 67.2 years) reported recent (within the previous 12 months) severe hypoglycemia, which was described in the baseline questionnaire as “severe low blood glucose reaction such as passing out or needing help to treat the reaction,” while 50% reported having a lifetime history of severe hypoglycemia.
After adjustment for age, sex, race/ethnicity, education, and diabetes duration, the researchers found that people with exposure to recent or lifetime severe hypoglycemia had significantly lower global cognition scores than those with no such exposure.
Domain-specific analyses revealed that individuals with recent severe hypoglycemia scored significantly lower on the language, executive function, and episodic memory tests than those without recent severe hypoglycemia, whereas people with any severe hypoglycemia exposure only performed significantly worse on executive function.
When Lacy and team defined impaired cognition as 1.5 standard deviations below the mean, they found that participants with four or more severe hypoglycemia episodes in the previous 12 months were 3.10 times more likely to have impaired global cognition than those with no such episodes, after adjustment for age, sex, race/ethnicity, education, and diabetes duration.
Further analysis revealed that the association was only significant in the language domain, with individuals who reported four or more recent severe hypoglycemia episodes a significant 3.08 times more likely to have impaired language function than those with no recent episodes.
By contrast, lifetime history of severe hypoglycemia was not significantly associated with impaired cognition at this cutoff either globally or on any of the specific domains.
The investigators comment that the cross-sectional nature of their data could mean that their findings “are being driven by reverse causation, whereby decreases in cognitive function are resulting in greater [severe hypoglycemia] exposure as opposed to the other way around.”
However, sensitivity analyses that were restricted to patients without cognitive impairment at baseline and that took lifetime severe hypoglycemia into account showed similar results.
Lacy et al believe that their study is the first of its scale to investigate how severe hypoglycemia impacts older adults with diabetes and conclude that their findings “complement and extend previous studies that have reported an association between [severe hypoglycemia] and decreased cognitive function in children and adolescents with [type 1 diabetes].”
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