Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

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BACKGROUND: Acute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients' expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia.

OBJECTIVE: This report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia.

METHODS: We performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients' expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global 'cognitive discrepancy' composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed).

RESULTS: Patients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = -1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. (β =" 0.4," age and capacity cognitive during for higher hypoglycaemia hypoglycaemia-related iq more of p =" 0.03).</p" patients pronounced shakiness underestimation verbal was with younger>

LIMITATIONS: The modest sample size limits the generalizability of the findings.

CONCLUSIONS: Patients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.

Original languageEnglish
Article number104431
JournalPsychoneuroendocrinology
Volume110
Number of pages6
ISSN0306-4530
DOIs
Publication statusPublished - 2019

ID: 227695972