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

TY - JOUR

T1 - 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

AU - Sepúlveda, Eduardo

AU - Poínhos, Rui

AU - Nata, Gil

AU - Gaspar, Nuno

AU - Freitas, Paula

AU - Vicente, Selene G.

AU - Amiel, Stephanie A.

AU - Carvalho, Davide

N1 - Publisher Copyright: © 2025 Elsevier B.V.

PY - 2025/3

Y1 - 2025/3

N2 - 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.

AB - 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.

KW - Barriers to activity

KW - Executive functioning

KW - Global cognition

KW - Impaired awareness of hypoglycemia

KW - Psychological distress

KW - Severe hypoglycemia

KW - Type 1 diabetes

UR - https://www.scopus.com/pages/publications/85216443152

U2 - 10.1016/j.diabres.2025.112004

DO - 10.1016/j.diabres.2025.112004

M3 - Article

C2 - 39805380

AN - SCOPUS:85216443152

SN - 0168-8227

VL - 221

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

M1 - 112004

ER -