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|Title: ||Hypoglycaemia in adult humans, with and without type 1 diabetes and impaired awareness|
|Authors: ||Geddes, Jacqueline|
|Supervisor(s): ||Frier, Brian|
|Issue Date: ||5-Jul-2011|
|Publisher: ||The University of Edinburgh|
|Abstract: ||Hypoglycaemia is a very common side-effect of insulin therapy for diabetes and directly
affects cognitive function. It can be identified by the onset of symptoms and by blood
glucose monitoring. Impaired awareness of hypoglycaemia is an acquired syndrome in
people with insulin-treated diabetes. The definitions, frequency, causes, treatment and
prevention of clinical hypoglycaemia and the effects on, and moderators of, cognitive
function will be discussed.
Two studies have examined the effects of hypoglycaemia on tests of particular cognitive
domains in subjects with and without type 1 diabetes. Three further studies have
examined the frequency of hypoglycaemia in people with and without impaired
awareness, the prevalence of impaired awareness of hypoglycaemia (IAH) and have
compared methods of assessing awareness of hypoglycaemia.
In study 1 the effect of acute hypoglycaemia on psychomotor function was examined in
healthy volunteers (n =20) and adults with type 1 diabetes (n=16). Although acute
hypoglycaemia caused significant impairment of several psychomotor functions in nondiabetic
adults, a lower magnitude of impairment was observed in those with type 1
diabetes. The potential mechanisms behind this are discussed.
In study 2 the effect of acute hypoglycaemia on a simple two-choice reaction time test,
which has a model with validated performance parameters, was examined in 14 nondiabetic
volunteers. Application of the validated model to the results of this task
revealed that hypoglycaemia affected central processing and was not related to the
amount of evidence required to make a decision or to peripheral and motor processes.
This study is the first to use this method to dissect the effects of hypoglycaemia on
cognition and enhances understanding of the mechanism underlying neuroglycopenia in
In Study 3 the methods of evaluating awareness of hypoglycaemia were compared in
people with type 1 diabetes. Good concordance in clinical characteristics and frequency
of biochemical hypoglycaemia was observed between the methods described by Gold et
al and Clarke et al but not with a Danish method.
In study 4 continuous glucose monitoring (CGM) and home blood glucose monitoring
were performed prospectively for 12 months in people with and without IAH. Those
with IAH had a 1.6-fold higher incidence of biochemical hypoglycaemia as
demonstrated by blood glucose monitoring, but CGM did not identify patients with
In study 5 the prevalence of IAH in a large clinic population with type 1 diabetes was
estimated and compared with earlier assessments. The overall prevalence was 20%.|
|Appears in Collections:||Molecular, Genetic and Population Health Sciences thesis and dissertation collection|
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