Consistent effects of hypoglycemia on cognitive function in people with or without diabetes

Clementine E. M. Verhulst; Therese W. Fabricius; Giesje Nefs; Roy P. C. Kessels; Frans Pouwer; Steven Teerenstra; Cees J. Tack; Melanie M. Broadley; Peter L. Kristensen; Rory J. McCrimmon; Simon Heller; Mark L. Evans; Ulrik Pedersen-Bjergaard; Bastiaan E. de Galan

doi:10.2337/dc21-2502

Consistent effects of hypoglycemia on cognitive function in people with or without diabetes

Clementine E. M. Verhulst^*
, Therese W. Fabricius
, Giesje Nefs
, Roy P. C. Kessels
, Frans Pouwer
, Steven Teerenstra
, Cees J. Tack
, Melanie M. Broadley
, Peter L. Kristensen
, Rory J. McCrimmon
, Simon Heller
, Mark L. Evans
, Ulrik Pedersen-Bjergaard
, Bastiaan E. de Galan

^*Corresponding author for this work

Medical and Clinical Psychology

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Objective

Hypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose level

Research design and methods

Adults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 +/- 0.13 mmol/L [50.2 +/- 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP).

Results

For the whole group, hypoglycemia decreased the mean +/- SD proportion of correct answers on the PASAT by 8.4 +/- 12.8%, increased reaction time on the TAP Alertness task by 32.1 +/- 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 +/- 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA(1c).

Conclusions

IHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia

Original language	English
Pages (from-to)	2103-2110
Journal	Diabetes Care: The Journal of Clinical and Applied Research and Education
Volume	45
Issue number	9
DOIs	https://doi.org/10.2337/dc21-2502
Publication status	Published - Sept 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

IMPAIRED AWARENESS
SLEEP-DEPRIVATION
RECOVERY
SYMPTOMS

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10.2337/dc21-2502

MCP Nefs consistent effects of hypoglycemia DC 2022Final published version, 18 MB

Cite this

Verhulst, C. E. M., Fabricius, T. W., Nefs, G., Kessels, R. P. C., Pouwer, F., Teerenstra, S., Tack, C. J., Broadley, M. M., Kristensen, P. L., McCrimmon, R. J., Heller, S., Evans, M. L., Pedersen-Bjergaard, U., & de Galan, B. E. (2022). Consistent effects of hypoglycemia on cognitive function in people with or without diabetes. Diabetes Care: The Journal of Clinical and Applied Research and Education, 45(9), 2103-2110. https://doi.org/10.2337/dc21-2502

@article{e4d5b02f39d342dfa01dac78be2bb5e8,

title = "Consistent effects of hypoglycemia on cognitive function in people with or without diabetes",

abstract = "ObjectiveHypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose levelResearch design and methodsAdults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 +/- 0.13 mmol/L [50.2 +/- 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP).ResultsFor the whole group, hypoglycemia decreased the mean +/- SD proportion of correct answers on the PASAT by 8.4 +/- 12.8\%, increased reaction time on the TAP Alertness task by 32.1 +/- 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 +/- 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA(1c).ConclusionsIHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia",

keywords = "IMPAIRED AWARENESS, SLEEP-DEPRIVATION, RECOVERY, SYMPTOMS",

author = "Verhulst, \{Clementine E. M.\} and Fabricius, \{Therese W.\} and Giesje Nefs and Kessels, \{Roy P. C.\} and Frans Pouwer and Steven Teerenstra and Tack, \{Cees J.\} and Broadley, \{Melanie M.\} and Kristensen, \{Peter L.\} and McCrimmon, \{Rory J.\} and Simon Heller and Evans, \{Mark L.\} and Ulrik Pedersen-Bjergaard and \{de Galan\}, \{Bastiaan E.\}",

note = "This study has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (which receives support from the European Union{\textquoteright}s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations and T1D Exchange, JDRF, International Diabetes Federation, and The Leona M. and Harry B. Helmsley Charitable Trust) under grant agreement no. 777460.",

year = "2022",

month = sep,

doi = "10.2337/dc21-2502",

language = "English",

volume = "45",

pages = "2103--2110",

journal = "Diabetes Care: The Journal of Clinical and Applied Research and Education",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "9",

}

Verhulst, CEM, Fabricius, TW, Nefs, G, Kessels, RPC, Pouwer, F, Teerenstra, S, Tack, CJ, Broadley, MM, Kristensen, PL, McCrimmon, RJ, Heller, S, Evans, ML, Pedersen-Bjergaard, U & de Galan, BE 2022, 'Consistent effects of hypoglycemia on cognitive function in people with or without diabetes', Diabetes Care: The Journal of Clinical and Applied Research and Education, vol. 45, no. 9, pp. 2103-2110. https://doi.org/10.2337/dc21-2502

TY - JOUR

T1 - Consistent effects of hypoglycemia on cognitive function in people with or without diabetes

AU - Verhulst, Clementine E. M.

AU - Fabricius, Therese W.

AU - Nefs, Giesje

AU - Kessels, Roy P. C.

AU - Pouwer, Frans

AU - Teerenstra, Steven

AU - Tack, Cees J.

AU - Broadley, Melanie M.

AU - Kristensen, Peter L.

AU - McCrimmon, Rory J.

AU - Heller, Simon

AU - Evans, Mark L.

AU - Pedersen-Bjergaard, Ulrik

AU - de Galan, Bastiaan E.

N1 - This study has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (which receives support from the European Union’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations and T1D Exchange, JDRF, International Diabetes Federation, and The Leona M. and Harry B. Helmsley Charitable Trust) under grant agreement no. 777460.

PY - 2022/9

Y1 - 2022/9

N2 - ObjectiveHypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose levelResearch design and methodsAdults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 +/- 0.13 mmol/L [50.2 +/- 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP).ResultsFor the whole group, hypoglycemia decreased the mean +/- SD proportion of correct answers on the PASAT by 8.4 +/- 12.8%, increased reaction time on the TAP Alertness task by 32.1 +/- 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 +/- 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA(1c).ConclusionsIHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia

AB - ObjectiveHypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose levelResearch design and methodsAdults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 +/- 0.13 mmol/L [50.2 +/- 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP).ResultsFor the whole group, hypoglycemia decreased the mean +/- SD proportion of correct answers on the PASAT by 8.4 +/- 12.8%, increased reaction time on the TAP Alertness task by 32.1 +/- 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 +/- 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA(1c).ConclusionsIHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia

KW - IMPAIRED AWARENESS

KW - SLEEP-DEPRIVATION

KW - RECOVERY

KW - SYMPTOMS

U2 - 10.2337/dc21-2502

DO - 10.2337/dc21-2502

M3 - Article

SN - 0149-5992

VL - 45

SP - 2103

EP - 2110

JO - Diabetes Care: The Journal of Clinical and Applied Research and Education

JF - Diabetes Care: The Journal of Clinical and Applied Research and Education

IS - 9

ER -

Consistent effects of hypoglycemia on cognitive function in people with or without diabetes

Abstract

UN SDGs

Keywords

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