Severe hypoglycemia (SH) is a common, yet life-threatening, complication of type 1 diabetes (T1D). SH, defined as an episode of low blood glucose requiring external help to recover, affects ∼30–50% of people with T1D annually . Among older adults with T1D (≥65 years of age) and those with long-standing diabetes (≥40 years’ duration), rates of SH are even higher.

With recent advances in treatment, individuals with T1D are living longer and are, thus, at increased risk for a number of aging-related diseases, such as cognitive decline and dementia. One of the major concerns surrounding SH is its possible long-term effects on cognition. Indeed, studies in individuals with type 2 diabetes (T2D) have reported associations between SH and cognitive decline and SH and dementia . In T1D, findings are less clear. Most studies have been conducted in children or young adults. In children, findings have generally supported an association between SH and cognitive impairment , with some exceptions . Studies in young adults, among them the Diabetes Control and Complications Trial (DCCT) and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, have not . To our knowledge, only one small study (n = 36 with T1D) has examined the association between exposure to SH and cognitive function in older adults with T1D . This study reported a significant association between SH and worse cognitive functioning. A possible explanation for these discrepant findings is that the brains of children and of older adults are more vulnerable than in middle age and thus more susceptible to the harm associated with SH. Understanding the association between SH and cognition in older adults with T1D is increasingly important given the growing population of older adults with T1D and the increased risk of both SH and cognitive decline in this population. It is especially important to delineate whether SH is differentially associated with certain domains of cognition; given the demanding self-care that is required with T1D, it is relevant to determine whether SH impacts executive function or memory—areas of cognition that, if impaired, interfere with an individual’s ability to properly manage T1D.

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Regards,

Jessica Celina

Managing Editor

Pancreatic disorders and Therapy