With the progress of diagnosis and treatment, the life expectancy of patients with type 1 diabetes is increasing, and this also brings new problems: patients with type 1 diabetes may face a higher risk of aging-related diseases, such as cognitive dysfunction and dementia
.
Studies in children and young adults have shown that poor blood sugar control and microvascular complications are associated with mild cognitive impairment
.
However, with age, whether and to what extent the cognition of patients with type 1 diabetes will decline, there is still a lack of long-term research evidence
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Recently, "The Lancet-Diabetes and Endocrinology" published 32-year follow-up results of important research in the field of type 1 diabetes, which provided new insights
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According to the research team, this is also "the first study that focuses on the cognitive decline risk factors for patients with type 1 diabetes from adolescence and youth to old age
.
"
The data published this time comes from the Diabetes Control and Complications Trial (DCCT) and its follow-up Diabetes Intervention and Complication Epidemiology (EDIC) study
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The results published earlier in this study have profoundly affected the diagnosis and treatment of type 1 diabetes.
The study provides a wealth of valuable information about the natural course of type 1 diabetes, showing that strict blood sugar control is essential to prevent diabetes complications
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This latest important long-term observation focuses on independent risk factors for cognitive decline in patients with type 1 diabetes
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This analysis included 1051 patients with type 1 diabetes from the DCCT and EDIC studies
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These patients completed the cognitive assessment at study baseline (median age 27 years), and study years 2, 5, 18, and 32 (median age 59 years)
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The research team also repeatedly evaluated the patient's HbA1c level, the frequency of severe hypoglycemia, non-glycemic risk factors (such as increased blood pressure), and microvascular and macrovascular complications, and evaluated these factors for the patient’s memory and consciousness activity (psychomotor) And mental efficiency
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During the 32-year follow-up, the research team found that in the second and fifth years, the memory, consciousness, and mental efficiency of these type 1 diabetic patients improved, but they all declined significantly over time
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Especially during the 18th to 32nd year follow-up period, the decline in consciousness activity and mental efficiency was 5 times the change in the previous 18 years! However, immediate memory and delayed memory mainly decline significantly in the later stages
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▲Cognitive function changes in patients with type 1 diabetes during follow-up, including immediate memory (blue), delayed memory (orange), conscious activity and mental efficiency (purple) (picture source: reference [1])
Analysis of influencing factors found that, independent of other risk factors and comorbidities, exposure to higher HbA1c levels, more severe hypoglycemia episodes and increased systolic blood pressure, these factors are more related to conscious activities and mental efficiency The decline is related, and this is most significant in the 32nd year
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For example, for every 1% increase in HbA1c level, the performance of conscious activity and mental efficiency is equivalent to aging 3.
3 years; every 5 mm Hg increase in systolic blood pressure is equivalent to aging 4 years; there have been ≥1 hypoglycemic events during the study period.
Equivalent to 4.
6 years old
.
The combined effect of these three risk factors is equivalent to an additional 9.
4 years old
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In contrast, patients with the best blood sugar control did not show any decline in conscious activity or mental efficiency during the observation period
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Based on these data, the research team pointed out that in patients with type 1 diabetes, cognitive function declines with aging
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Late adulthood is a time when neurocognitive changes are more likely to occur, which may be exacerbated by exposure to diabetes-related risk factors and complications, which may also represent the accumulation of effects over a longer period
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And better management of blood sugar and blood pressure levels may help preserve cognitive function
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Note: The original text has been deleted
Reference
[1] Alan M Jacobson, et al.
, (2021).
Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC Study.
The Lancet Diabetes & Endocrinology, DOI: https ://doi.
org/10.
1016/S2213-8587(21)00086-3
[2] Brian M Frier.
(2021).
Cognitive decline in longstanding type 1 diabetes: a role for severe hypoglycaemia.
The Lancet Diabetes & Endocrinology, DOI: https://doi.
org/10.
1016/S2213-8587(21)00117 -0
