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Delayed recovery of cognitive function following hypoglycemia in adults with type 1 diabetes: effect of impaired awareness of hypoglycemia

¹ Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK
² Department of Psychology, University of Edinburgh, Scotland, UK

Objective: Recovery times of cognitive functions were examined after exposure to hypoglycemia in people with diabetes with and without impaired hypoglycemia awareness.

Research Design and Methods: Thirty-six subjects with type 1 diabetes were studied (20 with normal hypoglycemia awareness {NHA}; 16 with impaired hypoglycemia awareness {IHA}). A hyperinsulinemic glucose clamp was used to lower blood glucose to 2.5 mmol/l (45 mg/dl) (hypoglycemia) for one hour, or to maintain blood glucose at 4.5 mmol/l (81mg/dl) (euglycemia), on separate occasions. Cognitive tests were applied during each experimental condition and repeated at 10-15 minute intervals for 90 minutes after euglycemia had been restored.

Results: In the NHA group, performance was impaired on all cognitive tasks during hypoglycemia and remained impaired for up to 75 minutes on the choice reaction time (CRT) task (p=0.03, ²=0.237). In the IHA group, performance did not deteriorate significantly during hypoglycemia. When all subjects were analyzed within the same general linear model, performance was impaired during hypoglycemia on all tasks. Significant impairment during recovery persisted for up to 40 minutes on the CRT task (p=0.04, ²=0.125) with a significant glycemia-awareness interaction for CRT after one hour of hypoglycemia (p=0.045, ²=0.124). Performance on the trail-making B task was impaired for up to 10 minutes after euglycemia was restored (p=0.024, ²=0.158).

Conclusions: Following hypoglycemia, the recovery time for different cognitive tasks varied considerably. In the IHA group, performance was not significantly impaired during hypoglycemia. The state of awareness of hypoglycemia may influence cognitive function during, and after, hypoglycemia.

Key Words: Type 1 diabetes • hypoglycaemia • hypoglycemia awareness • cognitive function • cognitive recovery.

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