Wredling R, Levander S, Adamson U, Lins P E
Department of Medicine, Danderyd Hospital, Sweden.
Diabetologia. 1990 Mar;33(3):152-7. doi: 10.1007/BF00404042.
Seventeen Type 1 (insulin-dependent) diabetic patients with a history of recurrent and severe hypoglycaemia and Type 1 diabetic patients with no severe hypoglycaemia were compared as regarded performances in tests of neuropsychological functioning. To test the hypothesis that recurrent severe hypoglycaemia gives rise to permanent cognitive impairment, the study group was selected among those patients who had met with repeated attacks over the last three years or more as identified by a questionnaire among almost 600 insulin-treated diabetic patients. The comparison group without known severe reactions were comparable to the study group with respect to type of diabetes, sex, age, age at onset, duration of diabetes, socio-economic parameters, and prevalence of neuropathy and retinopathy. The results indicate that Type 1 diabetic patients with recurrent severe hypoglycaemia scored lower than those without severe hypoglycaemia in tests of motor ability, short-term and associative memory and visuospatial tasks assessing ability in general problem-solving. Type 1 diabetic patients with severe hypoglycaemia also displayed a higher frequency of perspective reversals suggesting frontal-lobe involvement. These data can be interpreted in two ways. One interpretation implies that the cognitive impairment of Type 1 diabetic patients with severe hypoglycaemia reflects a selection factor, the other that recurrent episodes of severe hypoglycaemia result in permanent cognitive impairment.
对17名有反复严重低血糖病史的1型（胰岛素依赖型）糖尿病患者和无严重低血糖的1型糖尿病患者在神经心理功能测试中的表现进行了比较。为了验证反复严重低血糖会导致永久性认知障碍这一假设，研究组是从近600名接受胰岛素治疗的糖尿病患者中通过问卷调查筛选出的在过去三年或更长时间内有多次低血糖发作的患者。无已知严重反应的对照组在糖尿病类型、性别、年龄、发病年龄、糖尿病病程、社会经济参数以及神经病变和视网膜病变患病率方面与研究组相当。结果表明，有反复严重低血糖的1型糖尿病患者在运动能力、短期和联想记忆以及评估一般问题解决能力的视觉空间任务测试中的得分低于无严重低血糖的患者。有严重低血糖的1型糖尿病患者视角反转的频率也更高，提示额叶受累。这些数据可以有两种解释。一种解释是，有严重低血糖的1型糖尿病患者的认知障碍反映了一种选择因素，另一种解释是反复严重低血糖发作会导致永久性认知障碍。
