Relationship between severe hypoglycemia or impaired awareness of hypoglycemia and diabetes-related health status, global cognition and executive functions in adults with type 1 diabetes without severe anxiety or depression

Aims

To explore the relationship between impaired awareness of hypoglycemia (IAH) or severe hypoglycemia (SH), and health status and cognition in adults with type 1 diabetes (T1D).

Methods

T1D adults attending a tertiary diabetes service were recruited into this cross-sectional study. People screening positive for severe anxiety or depression were not included. Hypoglycemia awareness status was assessed using the full-scale and factor 1 of the Minimally Modified Clarke Hypoglycemia Survey (MMCHS; ≥4 and ≥2 = IAH); and data collected on health status (Diabetes Health Profile: barriers to activity, BA; psychological distress, PD; disinhibited eating); global cognition (Montreal Cognitive Assessment); and executive functions (EF; INECO Frontal Screening, IFS). A score of reduced awareness in item 3 and/or 4 of the MMCHS defined experience of ≥1 SH in past 6–12 months.

Results

In 165 T1D adults, prevalences of SH, IAH by MMCHS full-scale and factor 1 were 35%, 13% and 28%. Participants with IAH by factor 1 had higher scores for PD (p = 0.008). Participants with SH and IAH (full-scale or factor 1) had higher BA scores (all p < 0.05) but no impairment of global cognition or EF. Participant Z-score IFS was lower than in non-diabetic individuals (p < 0.001).

Conclusions

In our cohort, executive dysfunction in T1D was not associated with SH or IAH. IAH was associated with PD, and both SH and IAH were related to behavioral dysfunction.