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Hypoglycemia not linked to impaired cognitive function

The findings provide further support for the safety of intensive diabetes therapy and the benefits of maintaining good glycemic control.

Issue: July 2006

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WASHINGTON – Patients with diabetes who experience multiple severe hypoglycemic reactions do not appear to have an increased risk for impaired cognitive function, according to new research presented at the 66th Scientific Sessions of the American Diabetes Association, held here in June.

The research, presented by Alan M. Jacobson, MD, professor of psychiatry at Harvard Medical School and head of the Behavioral and Mental Health Research Section at the Joslin Diabetes Center in Boston, was a follow-up of findings from the Diabetes Control and Complications Trial (DCCT).

DCCT, which was funded by the National Institutes of Health, followed 1,441 people with type 1 diabetes for 10 years until 1993.

The study’s findings demonstrated that patients with diabetes who maintain tight blood glucose control are significantly less likely to develop further complications such as eye, kidney and nerve disease.

Findings from DCCT also indicated that patients who maintain tight blood glucose control may also be more likely to suffer episodes of severe hypoglycemia.

Because of these findings, there have been concerns that patients with diabetes who experienced episodes of severe hypoglycemia may have long-term risks for impaired cognitive function.

Follow-up

Jacobson and his colleagues conducted follow-up examinations on 1,059 people who had participated in the original DCCT trial and had been treated with either intensive diabetes therapy designed to improve conventional therapy. During DCCT, 537 patients were receiving intensive therapy with either an insulin pump or three or more daily insulin injections.

The remaining 522 patients were receiving conventional therapy of one or two injections daily.

During DCCT, patients were followed for an average of 6.5 years. The cognitive follow-up occurred 12 years after the end of DCCT and involved an average of 18 years of observation. During that period, 348 patients experienced one to five hypoglycemic events that resulted in a coma or seizure, and 59 patients reported more than five such events. The remaining 652 patients reported no such events.

Jacobson and his colleagues found no association between multiple severe hypoglycemic reactions and impaired cognitive function in patients with diabetes. Cognitive function for all patients was evaluated using the same neuropsychological tests that researchers administered during the DCCT trial. These tests evaluated eight cognitive domains: problem solving, learning, immediate memory, delayed recall, spatial information, attention, psychomotor efficiency and motor speed.

Cognitive function

After making adjustments for age, gender, years of education, length of follow-up and the number of cognitive tests taken, the researchers found no change in any of the eight areas when comparing those who have received intensive vs. conventional therapy or those with differing numbers of severe hypoglycemic events leading to coma or seizures. There was modest benefit for patients with better glycemic control on two of the cognitive domains: psychomotor efficiency and motor speed.

“This study provides further support for the safety of intensive diabetes therapy and the benefits of maintaining good glycemic control,” Jacobson said.

“While acute episodes of hypoglycemia can impair thinking and can even be life-threatening, patients do not have to worry that such episodes will impair their long-term abilities to perceive, reason and remember.”

Jacobson said these findings provide important and positive news for patients with diabetes. “These data were consistent with our last examination of cognition during the DCCT,” Jacobson told Endocrine Today. “Of course, there has been a lot of concern about the effects of severe hypoglycemia, so to not see any impact was a bit unexpected.”

Jacobson said that hypoglycemia should still be treated as an important concern for patients with diabetes. “Severe hypoglycemia can still be a very dangerous condition,” he said. “But with proper education, self-care and close medical follow-up, the risk of severe hypoglycemia can be lessened.” – by Jay Lewis

For more information:

• Jacobson A. Effects of intensive and conventional treatment on cognitive function twelve years after the completion of the Diabetes Control and Complications Trial. Presented at: The American Diabetes Association’s 66th Annual Scientific Sessions; June 9-13, 2006; Washington.