ArticleDiabetes/metabolism research and reviews2026
Clinical and Metabolic Predictors of Cognitive Impairment in Type 1 Diabetes: The Role of Peripheral Neuropathy and Hypoglycaemia Unawareness. Findings From a HAD-1 Study.
Article in Diabetes/metabolism research and reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsThis study evaluated the impact of selected clinical factors on cognitive impairment (CI), particularly diabetic peripheral neuropathy (DPN) and impaired awareness of hypoglycaemia (IAH) in individuals with long-standing type 1 diabetes (T1D). MATERIALS AND
methodsIn this cross-sectional Hypoglycaemia Awareness Study in Diabetes Type 1 (HAD-1), 252 adults with T1D were enrolled. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with CI defined as a MoCA score < 26. IAH was identified using validated questionnaires (Clarke scale, Gold scale and Hypoglycaemia Awareness Questionnaire).
resultsThe median MoCA score was 26 (23-28). CI was present in 122 subjects (48%), DPN in 85 subjects (34%) and IAH in 98 patients (39%). In univariate linear regression analysis, lower MoCA scores were associated with higher HbA1c (β = -0.30 and p = 0.017), older age (β = -0.03 and p = 0.014), a greater number of lifetime severe hypoglycaemia (SH) episodes (β = -0.17 and p = 0.001), DPN (β = -1.09 and p = 0.01) and higher skin autofluorescence (β = -0.72 and p = 0.03). In the multivariable regression analysis, IAH (β = -1.41 and p < 0.001), male sex (β = -0.89 and p = 0.022), higher HbA1c (β = -0.47 and p < 0.001) and higher vibration perception threshold (β = -0.049 and p = 0.004) were independent predictors of lower cognitive performance. Higher insulin dose (β = +2.92 and p = 0.012) was independently associated with better cognitive performance. In the interaction model, IAH (β = -1.54 and p = 0.003) and DPN (β = -1.18, p = 0.040) were independently associated with approximately 1.2-1.5-point lower MoCA scores.
conclusionsIn individuals with T1D, DPN and IAH, a history of SH, poorer metabolic control, older age and male sex are associated with CI. People with T1D should be screened for CI, especially if they have DPN or IAH.
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