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[IPu] ADA: Cognitive Function Preserved with Tight Control (Medpage)



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     ADA: Cognitive Function Preserved with Tight Glucose Control

        By Neil Osterweil, Senior Associate Editor, MedPage Today
            Reviewed by Zalman S. Agus, MD; Emeritus Professor at the
University of Pennsylvania School of Medicine.
            June 12, 2006


                  MedPage Today Action Points


                    a.. Explain to patients that tight glucose control with
frequent daily monitoring of blood glucose levels and adjustment of insulin
doses accordingly can significantly reduce the risk of type 1 diabetes
complications, and that episodes of hypoglycemia do not appear to harm thought
or reasoning processes.


                    b.. This study was published as an abstract and presented
orally at a conference. These data and conclusions should be considered to be
preliminary as they have not yet been reviewed and published in a
peer-reviewed publication.


            Review


                  Alan M. Jacobson
                  Josline Diabetes Center
            WASHINGTON, June 12 - Concerns that hypoglycemia from tight
glucose control could lead to impaired cognitive function can be laid to rest,
researchers reported here.


            In a long-term follow-up of more than 1,000 patients with type 1
diabetes who were part of the cohort of the landmark Diabetes Control and
Complications Trial (DCCT), investigators found no changes over time in any of
eight cognitive domains that had been monitored.


            "Now we know that patients don't have to worry about damaging
their mental abilities as they work to significantly decrease their risks of
developing diabetic retinopathy, neuropathy, nephropathy, and cardiovascular
disease," reported Alan M. Jacobson, M.D., of the Joslin Diabetes Center in
Boston at the American Diabetes Association meeting.


            The DCCT, which ended in 1993, followed patients with type 1
diabetes for a decade, ending in 1993. The trial conclusively demonstrated the
benefits of tight glucose control for preventing diabetes-associated
complications.


            In that trial, patients who managed to maintain glucose at a
near-normal physiologic level had a threefold risk for severe hypoglycemia,
leading to fears that frequent episodes of hypoglycemia and its attendant
consequences (confusion, irrational behavior, convulsions, and loss of
consciousness) could have a deleterious effect on cognitive function as
patients aged.


            In the current study, which is part of the DCCT follow-up called
Epidemiology of Diabetes Interventions and Complications Study (EDIC),
investigators looked at data on 1,059 of the participants in the DCCT, or
about 75% of the original cohort.


            Of these patients, 537 received intensive insulin therapy with
either an insulin pump or three or more daily insulin injections, while 522
continued with what was at the time conventional therapy of one or two insulin
shots per day.


            During the DCCT the patients were evaluated with a battery of
neuropsychological tests looking at cognitive abilities in eight domains,
including problem solving, learning, short-term memory, delayed recall,
spatial information, attention, psychomotor efficiency and psychomotor speed.


            The authors used a stricter definition of hypoglycemic event,
limiting it to episodes of diabetic coma or seizure, In the original trial the
definition included any event that required the assistance of another person.


            During the 6.5 year follow-up period of the current study, 652
patients reported no hypoglycemic events resulting in coma or seizure, 348
reported having one to five events, and 59 patients reported having more than
five events.


            When the patients were followed with the same neuropsychological
tests for the current study, the researchers saw no change in regard to
hypoglycemia over baseline in any of the eight domains after adjusting for
age, gender, years of education, length of followup and number of cognitive
tests taken. The findings were true for patients in both the intensive and
conventional glucose control groups.


            When they looked at HbA1c levels, however, they found that higher
levels (indicating less-tight glucose control) were associated with modest
declines in motor speed and psychomotor efficiency in the conventional
treatment group, but not significant changes in any of the other domains, and
that there was a significant difference in this measure favoring the intensive
glucose control group.

            The overall findings should be reassuring to patients who are
zealous about controlling their blood glucose levels, Dr. Jacobson said.


            "While acute episodes of hypoglycemia can impair thinking and can
even be life-threatening, patients with type 1 diabetes do not have to worry
that such episodes will impair their long-term abilities to perceive, reason,
and remember," he said.

            Related Articles:

              a.. ADA: 50-Year Type 1 Diabetes Survivors Show Islet Cells
              b.. ADA: Antidepressants Raise Diabetes Risk
              c.. ADA: Clinicians Found Remiss in Blood Pressure Control for
Diabetics
              d.. ADA: Diabetes Self-Care Tasks Demand Hours a Day
              e.. ADA: High Postmenopausal Sex Hormones Signal Type 2 Diabetes
Risk
              f.. ADA: Investigational Januvia Put Through Its Paces for
Diabetes
              g.. ADA: 'Polypill' Could Cut Diabetes-Related MIs in Half
              h.. ADA: Women with Preeclampsia Have Double the Type 2 Diabetes
Risk



            Primary source: 2006 American Diabetes Association Scientific
Sessions
            Source reference:
            Jacobson AM et al. "Effects of Intensive and Conventional
Treatment on Cognitive Function Twelve Years After the Completion of the
Diabetes Control and Complications Trial." Presented June 12, 2006.

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