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Low Cognitive Function With Low Glucose  

Feb 8, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy 

 Is brain health significantly lower in subjects that have been exposed to recent or lifetime severe hypoglycemia?  Examining the effect of type 1 diabetes on low cognitive function.

Managing type 1 diabetes can be quite the responsibility, especially if the patient has a case of severe hypoglycemia. Although the exact correlation between severe hypoglycemia and cognitive function is unknown, it is known that severe hypoglycemia is related to the pathogenesis of diabetes-related cognitive dysfunction in type 1 diabetes. In the early 1990s, patients with type 1 diabetes that presented with severe hypoglycemia were known to have some degree of cognitive dysfunction. Previous studies have shown that patients having type 1 diabetes and severe hypoglycemia have been associated with a decrease in the following cognitive dysfunctions: visual perception, speed of information processing, attention span, psychomotor efficiency, and mental flexibility.  

Understanding the role severe hypoglycemia has in brain health is essential. Given that the life expectancy of research participants and patients with type 1 diabetes is at a steady increase, cognitive health should be an area of concentration with all patients diagnosed with type 1 diabetes. This study aimed to investigate if being at risk for cognitive dysfunction is associated with severe hypoglycemia and glycemic levels.  

Even though cognitive impairment is thought to be more prevalent in patients that were diagnosed early on in life, it still affects late-life. In this study, 718 adults in their most senior years of life, diagnosed with type 1 diabetes, were examined by the Study of Longevity in Diabetes (SOLID). The study allowed a closer look at the specific connection severe hypoglycemia had with cognitive function. Researchers examined the participants’ reports twelve months before the beginning of the study, as well as gauged everyone’s global and domain-specific cognition. Both factors were weighed into the overall denouncement and evaluated using linear and logistic regression models. 

A year before the research began, every participant reported cases of severe hypoglycemia to a physician at a routine check-up. The subjects also proclaimed a lifetime history of severe hypoglycemia resulting in inpatient or emergency department utilization.  

Researchers also analyzed global and domain-specific cognition such as language, executive function, episodic memory, and simple attention in each participant.  At least fifty percent of the subjects reported lifetime severe hypoglycemia that was connected with a decline in executive function.  

Respectively, thirty-two percent of the participants with a mean of age of 67.2 years old were noted with recent severe hypoglycemia, and fifty percent were observed having severe lifetime hypoglycemia. The participants that reported recent critical hypoglycemia history had a significantly lower global cognition score compared to those with no severe hypoglycemia. The domain-specific analysis confirmed subjects with exposure to recent severe hypoglycemia had lower scores in language, executive function, and episodic memory. 

Results from the logistic regression models showed that participants with exposure to severe lifetime hypoglycemia reported lower executive function. Patients with exposure to more recent severe hypoglycemia were linked to impaired global cognition resulting in the odds ratio being 3.22 and 95% confidence interval. The subjects exposed to recent severe hypoglycemia also had findings of cognitive impairment on the language domain resulting in an odds ratio being 3.15 and confidence interval of 95%.   

Type 1 diabetes has been connected with a decrease in visual perception, speed of information processing, attention span, psychomotor efficiency, and mental flexibility in many studies. The most recent studies have shown those connections to be with hypoglycemic episodes, in general, resulting in cognitive dysfunction. Studies such as this one have confirmed the idea that only chronic stages of hypoglycemia can decrease cognitive function. This study found poor cognition amongst older adults with type 1 diabetes with recently diagnosed severe hypoglycemia and lifetime severe hypoglycemia. Patients with the most recent diagnosis of severe hypoglycemia had impaired global cognition. The findings propose that severe hypoglycemia has a disadvantageous effect on the health of the brain in older patients with type 1 diabetes.  

In conclusion, this study shows that health care providers need to understand the importance of severe hypoglycemia prevention. For a patient reporting any cognitive performance decline, screening and assessment is highly suggested.  

Practice Pearls: 

  • Patients with more recent diagnosis of severe hypoglycemia scored significantly lower in global cognition and several of the domain-specific analyses 
  • It is essential for health care providers to understand the importance of acute hypoglycemia prevention. 
  • Healthcare professionals should pride themselves on providing the best guidance to their patients concerning safe diabetic self-practices in spite of glucose levels. 

 

Diabetes Care 2019 Dec 27; [EPub Ahead of Print], ME Lacy, P Gilsanz, C Eng, MS Beeri, AJ Karter, RA Whitmer 

Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy