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Decreased cognitive function is associated with preceding severe hypoglycemia and impaired blood glucose control in the elderly individuals with type 1 diabetes



This investigation aimed to clarify the relationship between cognitive function and blood glucose control in the elderly individuals with type 1 diabetes.

Materials and methods

In total, 45 patients with type 1 diabetes, age 74.9 ± 6.7 years, and HbA1c levels of 7.9 ± 0.9% were studied. Severe hypoglycemia occurred in 33% of patients, and the number of severe hypoglycemia episodes was 0.6 ± 1.2 in the past 5 years before the time of the cognitive function tests. We analyzed clinical data and dementia scores on the Revised Hasegawa’s Dementia Scale (HDS-R), Mini-Mental State Examination (MMSE), and Dementia Assessment Sheet for Community-based Integrated Care System, and 21 items (DASC-21).


There was a significant correlation between HbA1c and HDS-R, MMSE, respectively. There was a significant correlation between the number of severe hypoglycemic episodes and HDS-R, MMSE, and DASC-21, respectively. When the group with experience of severe hypoglycemia was compared to the control group, HDS-R, MMSE, and DASC-21 were meaningfully different after adjusting for age modeling analysis of covariance.


In elderly individuals with type 1 diabetes, our results suggest that high HbA1c for the past 5 years from the cognitive function test and a history of severe hypoglycemic episodes from the time of disease diagnosis are related to decreased cognitive function.

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We would like to thank Professor Toshiaki Hanafusa, Honorary Director of Sakai City Medical Center for his critical comments in this investigation, and Dr. Keisuke Fukui and Dr. Yuri Ito for their support with the statistical analysis of this investigation.


This work was supported in part by JSPS KAKENHI (grant number 21K08538).

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Correspondence to Shou Shigemoto or Akihisa Imagawa.

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Conflict of interest

Akihisa Imagawa received honorarium for lectures from Astellas Pharma Inc.; clinical commissioned/joint research grant from Astra Zeneca, Soiken Inc., Taiho Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., and Merck KGaA, Parexel International Inc.; research grant from Shionogi Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company, and Shionogi & Co., Ltd. The other authors declare no conflict of interest.

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This study was approved by the ethics committee of Osaka Medical and Pharmaceutical University on May 1, 2018, as No.2439 and done according to the principles of the “Declaration of Helsinki.”

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Shigemoto, S., Imbe, H., Fujisawa, R. et al. Decreased cognitive function is associated with preceding severe hypoglycemia and impaired blood glucose control in the elderly individuals with type 1 diabetes. Diabetol Int 13, 679–686 (2022).

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  • Cognitive dysfunction
  • Hypoglycemia
  • Type 1 diabetes
  • Elderly individuals