Skip to main content

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Asao K, Sarti C, Forsen T, et al. Long-term mortality in nationwide cohorts of childhood-onset type 1 diabetes in Japan and Finland. Diabetes Care. 2003;26:2037–42.

    Article  Google Scholar 

  2. Essence and perspective of the JGS/JDS clinical practice guideline for the treatment of diabetes in the elderly. J Japan Geriatr Psychiatry 2018; 55: 1–12. [Japanese]

  3. Blasetti A, Chiuri RM, Tocco AM, et al. The effect of recurrent severe hypoglycemia on cognitive performance in children with type 1 diabetes: a meta-analysis. J Child Neurol. 2011;26:1383–91.

    Article  Google Scholar 

  4. Jacobson AM, Ryan CM, Cleary PA, et al. Biomedical risk factors for decreased cognitive functioning in type 1 diabetes: an 18-year follow-up of the diabetes control and complications trial (DCCT) cohort. Diabetologia. 2011;54:245–55.

    CAS  Article  Google Scholar 

  5. Jacobson AM, Musen G, Ryan CM, et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med. 2007;356:1842–52.

    Article  Google Scholar 

  6. Lacy ME, Gilsanz P, Eng C, et al. Severe hypoglycemia and cognitive function in older adults with type 1 diabetes: The study of longevity in diabetes (SOLID). Diabetes Care. 2020;43:541–8.

    Article  Google Scholar 

  7. Sakurai T, Iimuro S, Sakamaki K, et al. Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese elderly diabetes intervention trial. Geriatr Gerontol Int. 2012;12(Suppl 1):117–26.

    Article  Google Scholar 

  8. Kato S, Shimogaki H, Onodera A, et al. Development of the revised version of Hasegawa’s Dementia Scale (HDS-R). J Japan Geriatr Psychiatry. 1991;2:1339–47.

    Google Scholar 

  9. Tariq SH, Tumosa N, Chibnall JT, et al. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder–a pilot study. Am J Geriatr Psychiatry. 2006;14:900–10.

    Article  Google Scholar 

  10. Saxton J, Morrow L, Eschman A, et al. Computer assessment of mild cognitive impairment. Postgrad Med. 2009;121:177–85.

    Article  Google Scholar 

  11. Kaufer DI, Williams CS, Braaten AJ, et al. Cognitive screening for dementia and mild cognitive impairment in assisted living: comparison of 3 tests. J Am Med Dir Assoc. 2008;9:586–93.

    Article  Google Scholar 

  12. Awata S, Sugiyama M, Ito K, et al. Development of the dementia assessment sheet for community-based integrated care system. Geriatr Gerontol Int. 2016;16(Suppl 1):123–31.

    Article  Google Scholar 

  13. Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the committee of Japan diabetes society on the research of fulminant and acute-onset type 1 diabetes mellitus. J Diabetes Investig. 2014;5:115–8.

    CAS  Article  Google Scholar 

  14. Tanaka S, Ohmori M, et al. Committee on type 1 diabetes, diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the committee on slowly progressive insulin-dependent (Type 1) diabetes mellitus of the Japan diabetes society. Diabetol Int. 2015;6:1–7.

    Article  Google Scholar 

  15. Kobayashi T, Tanaka S, Harii N, et al. Immunopathological and genetic features in slowly progressive insulin-dependent diabetes mellitus and latent autoimmune diabetes in adults. Ann N Y Acad Sci. 2006;1079:60–6.

    CAS  Article  Google Scholar 

  16. Imagawa A, Hanafusa T, Awata T, et al. Report of the committee of the japan diabetes society on the research of fulminant and acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). J Diabetes Investig. 2012;3:536–9.

    Article  Google Scholar 

  17. Yaffe K, Falvey CM, Hamilton N, et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med. 2013;173:1300–6.

    Article  Google Scholar 

  18. Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005;28:726–35.

    Article  Google Scholar 

  19. de Galan BE, Zoungas S, Chalmers J, et al. Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the action in diabetes and vascular disease: preterax and diamicron modified release controlled evaluation (ADVANCE) trial. Diabetologia. 2009;52:2328–36.

    Article  Google Scholar 

  20. Bordier L, Doucet J, Boudet J, et al. Update on cognitive decline and dementia in elderly patients with diabetes. Diabetes Metab. 2014;40:331–7.

    CAS  Article  Google Scholar 

  21. Lee CW, Shih YH, Wu SY, et al. Hypoglycemia induces tau hyperphosphorylation. Curr Alzheimer Res. 2013;10:298–308.

    CAS  Article  Google Scholar 

  22. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18:643–62.

    Article  Google Scholar 

  23. Crowe SF. The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on parts A and B of the trail making test. J Clin Psychol. 1998;54:585–91.

    CAS  Article  Google Scholar 

  24. Amaresha AC, Danivas V, Shivakumar V, et al. Clinical correlates of parametric digit-symbol substitution test in schizophrenia. Asian J Psychiatr. 2014;10:45–50.

    Article  Google Scholar 

  25. Maggi S, Noale M, Pilotto A, et al. The metabolic study: multidimensional assessment of health and functional status in older patients with type 2 diabetes taking oral antidiabetic treatment. Diabetes Metab. 2013;39:236–43.

    CAS  Article  Google Scholar 

  26. Araki A, Ito H. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int. 2009;9:105–14.

    Article  Google Scholar 

Download references


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).

Author information

Authors and Affiliations


Corresponding authors

Correspondence to Shou Shigemoto or Akihisa Imagawa.

Ethics declarations

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.

Human and animal rights

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.”

Informed Consent

Informed consent was obtained in the form of an opt-out on the website.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


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