Hypoglycemia, Hypertension Tied to Cognitive Decline in Type 1 Diabetes

By Marilynn Larkin

June 14, 2021

NEW YORK (Reuters Health) - Patients with type 1 diabetes may be at greater risk of cognitive decline as they age, especially if they have high blood sugar, bouts of severe hypoglycemia and/or high blood pressure, researchers say.

For individuals with type 1 diabetes, "the effectiveness of avoiding high blood pressure and high blood sugar levels over time on cognitive function is very consistent, with similar effects on other organs, such as heart and blood vessels," Dr. Alan Jacobson of NYU Long Island School of Medicine in Mineola, New York told Reuters Health by email.

"Importantly, on average these participants experienced relatively mild changes in their thinking and cognitive performance as they entered older adult years," he added. "The biggest effects were relatively circumscribed, and were seen on tasks that required rapid responding. The effects on memory were relatively small."

As reported in The Lancet Diabetes and Endocrinology, Dr. Jacobson and colleagues studied 1,051 participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study.

Participants completed cognitive assessments at baseline (median age, 27) and two, five, 18, and 32 years later (median age, 59). HbA1c levels, frequency of severe hypoglycemia, non-glycemic risk factors such as elevated blood pressure, and microvascular and macrovascular complications were assessed repeatedly.

Declines in memory and psychomotor and mental efficiency were found during the 32 years of follow-up; the decline was five times larger than the change from baseline to year 18.

Independent risk factors were higher HbA1c levels, more episodes of severe hypoglycemia, and elevated systolic blood pressure; these were associated with greater decrements in psychomotor and mental efficiency that were most notable by year 32.

The combined effect of these three risk factors was equivalent to an additional 9.4 years of age.

The authors conclude that better management of those risks might preserve cognitive function.

Dr. Jacobson said, "A focus on blood sugar and blood pressure management can pay dividends. Diabetes is a long haul. Change takes time. Providing support for patients having greater challenges meeting goals of care can make a difference."

"We need to see how these effects play out as people with type 1 diabetes age further," he added. "We are looking at how these biomedical risk factors affect the brain directly...Are cognitive effects due to blood vessel issues or other factors? Understanding mechanisms can lead to improved methods of treatment."

Dr. Brian Frier of the Queen's Medical Research Institute, University of Edinburgh, author of a related editorial, commented in an email to Reuters Health, "It has long been suspected that adverse effects of recurrent exposure to severe hypoglycemia on the brain may be cumulative and will eventually cause cognitive impairment."

"The long-term follow-up of the DCCT/EDIC participants has confirmed the potential risk that severe hypoglycemia can impose on cognitive function and strongly emphasizes the importance of avoiding this serious side effect of insulin in the centenary year of its discovery," he concluded.

SOURCE: https://bit.ly/3ixJqaz and https://bit.ly/3grBXHA The Lancet Diabetes and Endocrinology, online May 27, 2021.

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