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J Diabetes Complications. 2019 Jan;33(1):91-97. doi: 10.1016/j.jdiacomp.2018.04.003. Epub 2018 Apr 14.

Clinically significant cognitive impairment in older adults with type 1 diabetes.

Author information

1
Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States. Electronic address: naomic@wsu.edu.
2
College of Nursing, Washington State University, Spokane, WA, United States.
3
University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
4
Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States; Psychiatry Department, Harvard Medical School, Boston, MA, United States.
5
University of Washington School of Medicine, Seattle, WA, United States.
6
Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.

Abstract

AIMS:

Little is known about cognition in older adults with type 1 diabetes. The aim of this study was to identify correlates of clinically significant cognitive impairment.

METHODS:

Neuropsychological, diabetes-related and glycemic (HbA1c, Continuous Glucose Monitoring; CGM) data were collected from 201 older adults (≥60 years) with longstanding type 1 diabetes.

RESULTS:

Clinically significant cognitive impairment (≥2 cognitive tests ≥1.5 SD below normative data) occurred in 48% of the sample. After controlling for age, gender, education and diabetes duration, we found that hypoglycemia unawareness, recent severe hypoglycemic events, any microvascular complication, higher HbA1c and CGM average nocturnal glucose were all associated with increased odds of clinically significant cognitive impairment (ORs = 1.01-2.61), while CGM nocturnal % time below 60 mg/dL was associated with a decreased odds of cognitive impairment (OR = 0.94). Diabetes duration, diagnosis age, daytime CGM, and lifetime severe hypoglycemic events were not related to cognitive impairment status.

CONCLUSIONS:

Clinically significant cognitive impairment was common in older adults with type 1 diabetes. Diabetes-related correlates of cognitive impairment were identified, including hypoglycemia unawareness, recent severe hypoglycemic events, and CGM variables. Longitudinal research is needed to determine if these variables predict cognitive decline and if their modification alters outcomes.

KEYWORDS:

Aging; Cognition; Hypoglycemia; Neuropsychology; Older adults; Type 1 diabetes

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