Long-term effect of diabetes and its treatment on cognitive function.
Long-term effect of diabetes and its treatment on cognitive function.
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DOI：
10.1056/nejmoa066397
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发表时间：
2007-05
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影响因子：
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通讯作者：
A. Jacobson;G. Musen;C. Ryan;N. Silvers;P. Cleary;B. Waberski;Amanda Burwood;K. Weinger;M. Bayless;W. Dahms;J. Harth
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作者：
A. Jacobson;G. Musen;C. Ryan;N. Silvers;P. Cleary;B. Waberski;Amanda Burwood;K. Weinger;M. Bayless;W. Dahms;J. Harth
背景1型糖尿病对认知能力影响的长期关注随着设计用于使葡萄糖水平接近非糖尿病范围的治疗的使用而增加，并且伴随严重低血糖的风险增加。方法：共有1144例1型糖尿病患者参加了糖尿病控制和并发症试验（DCCT）及其后续糖尿病干预和并发症流行病学（EDIC）研究，在进入DCCT时（平均年龄27岁）和平均18年后进行了相同的综合认知测试。在随访期间测量糖化血红蛋白水平，并记录导致昏迷或癫痫发作的严重低血糖事件的频率。我们评估了初始DCCT治疗组分配、平均糖化血红蛋白值和低血糖事件频率对认知能力指标的影响，并对基线年龄、性别、受教育年限、随访时间、视力、自我报告的周围神经病变引起的感觉丧失、以及（为了控制练习的影响）DCCT开始后的间隔内进行的认知测试的数量。结果40%的队列报告至少有一次低血糖昏迷或癫痫发作。重度低血糖的频率和既往治疗组分配均与任何认知领域的下降无关。较高的糖化血红蛋白值与运动速度（P=0.001）和精神效率（P<0.001）的中度下降相关，但其他认知领域没有受到影响。结论：在一个平均随访18年的1型糖尿病患者大组中，没有发现认知功能长期下降的证据，尽管复发性严重低血糖的发生率相对较高。（ClinicalTrials.gov编号，NCT 00360893。）
BACKGROUND Long-standing concern about the effects of type 1 diabetes on cognitive ability has increased with the use of therapies designed to bring glucose levels close to the nondiabetic range and the attendant increased risk of severe hypoglycemia. METHODS A total of 1144 patients with type 1 diabetes enrolled in the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study were examined on entry to the DCCT (at mean age 27 years) and a mean of 18 years later with the same comprehensive battery of cognitive tests. Glycated hemoglobin levels were measured and the frequency of severe hypoglycemic events leading to coma or seizures was recorded during the follow-up period. We assessed the effects of original DCCT treatment-group assignment, mean glycated hemoglobin values, and frequency of hypoglycemic events on measures of cognitive ability, with adjustment for age at baseline, sex, years of education, length of follow-up, visual acuity, self-reported sensory loss due to peripheral neuropathy, and (to control for the effects of practice) the number of cognitive tests taken in the interval since the start of the DCCT. RESULTS Forty percent of the cohort reported having had at least one hypoglycemic coma or seizure. Neither frequency of severe hypoglycemia nor previous treatment-group assignment was associated with decline in any cognitive domain. Higher glycated hemoglobin values were associated with moderate declines in motor speed (P=0.001) and psychomotor efficiency (P<0.001), but no other cognitive domain was affected. CONCLUSIONS No evidence of substantial long-term declines in cognitive function was found in a large group of patients with type 1 diabetes who were carefully followed for an average of 18 years, despite relatively high rates of recurrent severe hypoglycemia. (ClinicalTrials.gov number, NCT00360893.)