Long-term study shows brain function not impaired by tight diabetes control and hypoglycemia

BOSTON -- The landmark Diabetes Control and Complications Trial (DCCT) funded by the National Institutes of Health, which followed 1,441 people with type 1 diabetes for a decade until 1993, showed conclusively that tight blood glucose control significantly reduces the risk of developing complications of diabetes such as eye, kidney and nerve disease. But the DCCT also showed that tight control -- achieved by taking three or more insulin injections daily -- can come at a cost: Patients in the trial who kept their blood glucose levels as close to the normal range as possible were three times as likely to suffer episodes of severe hypoglycemia -- abnormally low blood glucose levels that can cause confusion, irrational behavior, convulsions and unconsciousness. This finding raised the fear that, although tight control may lower the risk of developing other diabetes complications, it might also lead to a long-term loss of cognitive ability.

Now there is good news from Joslin Diabetes Center researchers in collaboration with investigators at the University of Pittsburgh Medical Center, George Washington University and the DCCT/EDIC Research Group. After following three-quarters of the original DCCT participants for an additional 6.5 years, the researchers found no link between multiple severe hypoglycemic reactions and impaired cognitive function in people with type 1 diabetes in the study. "This study provides further support for the safety of intensive diabetes therapy and the benefits of maintaining good glycemic control," says the study's principal investigator, Alan M. Jacobson, M.D., head of Joslin's Behavioral and Mental Health Research Section and Professor of Psychiatry at Harvard Medical School. "While acute episodes of hypoglycemia can impair thinking and can even be life-threatening, patients with type 1 diabetes do not have to worry that such episodes will impair their long-term abilities to perceive, reason and remember."

The study is among a

Contact: Marjorie Dwyer
Joslin Diabetes Center

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