Ryan C M, Williams T M, Finegold D N, Orchard T J
Department of Psychiatry, University of Pittsburgh, School of Medicine, Pennsylvania.
Diabetologia. 1993 Apr;36(4):329-34. doi: 10.1007/BF00400236.
To examine the long-term effects of recurrent severe hypoglycaemia and other biomedical complications on mental efficiency, a battery of cognitive tests was administered to 142 Type 1 (insulin-dependent) diabetic adult patients (age 33.5 +/- 5.6 years; mean +/- SD) and 100 demographically similar non-diabetic control subjects. All diabetic subjects had been diagnosed before the age of 17 years. Diabetic subjects with one or more complications (distal symmetrical polyneuropathy; advanced background or proliferative retinopathy; overt nephropathy; one or more episodes of severe hypoglycaemia) performed significantly (p < 0.001) more poorly than non-diabetic control subjects on tests requiring sustained attention, rapid analysis of visuospatial detail, and hand eye co-ordination. Regression analyses indicated that the best biomedical predictor of cognitive test performance was a diagnosis of polyneuropathy. Although severe recurrent hypoglycaemia was not associated with performance on any test, the neuropathy x recurrent hypoglycaemia interaction term was significant. These results suggest that in adults with Type 1 diabetes of long duration, recurrent hypoglycaemia does not appear to influence cognitive performance directly, but may interact with neuropathy to exaggerate or otherwise magnify the extent of neurobehavioural dysfunction.
为了研究反复严重低血糖及其他生物医学并发症对心理效能的长期影响，对142名1型（胰岛素依赖型）成年糖尿病患者（年龄33.5±5.6岁；均值±标准差）和100名人口统计学特征相似的非糖尿病对照者进行了一系列认知测试。所有糖尿病患者均在17岁之前被诊断。患有一种或多种并发症（远端对称性多发性神经病变；晚期背景性或增殖性视网膜病变；显性肾病；一次或多次严重低血糖发作）的糖尿病患者在需要持续注意力、快速分析视觉空间细节以及手眼协调的测试中的表现明显（p<0.001）比非糖尿病对照者差。回归分析表明，认知测试表现的最佳生物医学预测指标是多发性神经病变的诊断。虽然严重反复低血糖与任何测试的表现均无关联，但神经病变×反复低血糖的交互项具有显著性。这些结果表明，在病程较长的1型糖尿病成年患者中，反复低血糖似乎不会直接影响认知表现，但可能与神经病变相互作用，加剧或放大神经行为功能障碍的程度。
