Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

on behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators, Insa Feinkohl, Phyu Phyu Aung, Marketa Keller, Christine M Robertson, Joanne R Morling, Stela McLachlan, Ian J Deary, Brian M Frier, Mark W J Strachan, Jackie F Price

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Abstract / Description of output

ObjectivePeople with type 2 diabetes are at increased risk of age-related cognitive decline and dementia. Hypoglycemia is a candidate risk factor, but the direction of association between episodes of severe hypoglycemia and cognitive decline in type 2 diabetes remains uncertain.Research Design and MethodsIn the Edinburgh Type 2 Diabetes Study (ET2DS), cognitive function was assessed in 831 adults with type 2 diabetes (60-75 years) at baseline and after 4 years. Scores on seven neuropsychological tests were combined into a standardized general ability factor 'g'. Self-reported history of severe hypoglycemia at baseline (history of hypoglycemia) and at follow-up (incident hypoglycemia) was recorded.Results9.3% subjects reported a history of hypoglycemia; 10.2% reported incident hypoglycemia. Incident hypoglycemia was associated with poorer cognitive ability at baseline (age- and sex-adjusted OR for lowest tertile of g 2.04; 95% CI 1.25, 3.31; p=0.004). Both history of hypoglycemia and incident hypoglycemia were also associated with greater cognitive decline during follow up (mean follow-up g adjusted for age, sex, baseline g, -0.25 versus 0.03, p=0.02 and -0.28 versus 0.04, p=0.01 respectively), including after addition of vascular risk factors, cardiovascular and microvascular disease to the models (-0.23 versus 0.03, p=0.04 and -0.21 versus 0.05, p=0.03, respectively).ConclusionsThe relationship between cognitive impairment and hypoglycemia appeared complex, with severe hypoglycemia associated with both poorer initial cognitive ability and accelerated cognitive decline.
Original languageEnglish
Article number0863
JournalDiabetes Care
Early online date8 Oct 2013
Publication statusPublished - 2013


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