Abstract P011: Hypoglycemia Unawareness is Associated With Impaired Cognition Among Older Adults With Type 1 Diabetes: the Study of Longevity in Diabetes

The recurrence of hypoglycemic episodes leads to attenuation of the normal counter-regulatory mechanisms that are controlled by the hypothalamus, which results in hypoglycemia unawareness (HU). In this case report, we described for the first time the differential expression of TNF-α, IL-1β, IL-6, and IFN-γ in a blood sample that was taken from a 27-year-old patient with type 1 diabetes mellitus (T1DM) who was diagnosed with HU. The anti-diabetic regimen is currently based on insulin injection, but the patient is planning to start the use of an insulin pump to have better control of glucose levels. Our results showed a trend toward an increase in the expression of IL-1β, IL-6, and IFN-γ in T1DM patient with HU. However, the mRNA level of TNF-α showed a significant decrease. These observations suggest that systemic inflammation could be an underlying cause of HU.

Download Full-text

Point-of-Care Nerve Conduction for the Identification of Neuropathy in Older Adults with Type 1 Diabetes

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2017.08.174 ◽

2017 ◽

Vol 41 (5) ◽

pp. S63

Author(s):

Daniel Scarr ◽

Leif E. Lovblom ◽

Nancy Cardinez ◽

Andrej Orszag ◽

Mohammed A. Farooqi ◽

...

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Nerve Conduction ◽

Point Of Care

Download Full-text

Real world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed loop use

Diabetes Obesity and Metabolism ◽

10.1111/dom.14441 ◽

2021 ◽

Author(s):

Cari Berget ◽

Halis Kaan Akturk ◽

Laurel H Messer ◽

Timothy Vigers ◽

Laura Pyle ◽

...

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Young Adults ◽

Real World ◽

Closed Loop

Download Full-text

147-OR: Use of Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Experience

Diabetes ◽

10.2337/db21-147-or ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 147-OR

Author(s):

ELENA TOSCHI ◽

CHRISTINE SLYNE ◽

ASTRID ATAKOV-CASTILLO ◽

MEDHA MUNSHI

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Real World ◽

Closed Loop

Download Full-text

Closed-Loop Insulin Therapy in older adults with Type 1 Diabetes: real-world data

Diabetes Technology & Therapeutics ◽

10.1089/dia.2021.0311 ◽

2021 ◽

Author(s):

Elena Toschi ◽

Astrid Atakov-Castillo ◽

Christine Slyne ◽

Medha Munshi

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Real World ◽

Closed Loop ◽

Real World Data ◽

World Data

Download Full-text

Hypoglycemia-Associated Autonomic Failure in Type 1 Diabetes: Beyond Hypoglycemia Unawareness

Clinical Diabetes ◽

10.2337/cd21-0100 ◽

2021 ◽

pp. cd210100

Author(s):

Aristeidis Giannakopoulos ◽

Alexandra Efthymiadou ◽

Anastasia Chrysanthakopoulou ◽

Dionisios Chrysis

Keyword(s):

Type 1 Diabetes ◽

Autonomic Failure ◽

Hypoglycemia Unawareness

Download Full-text

1120-P: Sex Differences in the Burden of Diabetes-Related Complications among Older Adults with Type 1 Diabetes

Diabetes ◽

10.2337/db21-1120-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 1120-P

Author(s):

MARY ELIZABETH L. LEIGH ◽

PAOLA GILSANZ ◽

CHRIS MORAN ◽

ANDREW J. KARTER ◽

RACHEL A. WHITMER

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Sex Differences

Download Full-text

Abstract P268: Greater Cognitive Impairment Among Older Adults With Type 1 Diabetes as Compared to Non-diabetic Controls: Results From the Study of Longevity in Diabetes (SOLID)

Circulation ◽

10.1161/circ.141.suppl_1.p268 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Mary E Lacy ◽

Paola Gilsanz ◽

Chloe Eng ◽

Michal S Beeri ◽

Andrew J Karter ◽

...

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Cognitive Impairment ◽

Executive Function ◽

Cognitive Function ◽

Episodic Memory ◽

Regression Models ◽

Cognitive Test ◽

Race Ethnicity

Introduction: Studies have shown poorer cognitive function in children and adolescents with type 1 diabetes (T1D) as compared to non-diabetic peers. However, little is known about cognitive function in older adults with T1D. Hypothesis: We hypothesized that older adults with T1D and type 2 diabetes (T2D) would have greater cognitive impairment than age, sex, race/ethnicity, and education-matched controls without diabetes. Methods: We compared baseline cognitive impairment among older adults (aged ≥60) from the Study of Longevity in Diabetes (SOLID) with T1D (n=771), T2D (=234) and no diabetes (n=253). Cognitive tests assessed three cognitive domains identified via factor analysis (language, executive function, episodic memory). All cognitive test scores were standardized and cognitive impairment was defined as 1.5 SD below the mean. In logistic regression models adjusted for age, sex, education, and race/ethnicity, we examined the association between diabetes status (T1D, T2D or no diabetes) and cognition on each cognitive domain and on global cognition (average of scores on the 3 domains). Results: In adjusted regression models, compared to older adults without diabetes, those with T1D were more likely to have impaired cognitive function on the language (OR=2.13, 95% CI: 1.08, 4.17) and executive function domains (OR=2.66, 95% CI: 1.36, 5.22). No significant differences in global cognitive impairment or impairment on the episodic memory domain were observed for T1D and no significant differences on any domain were observed for T2D. Conclusions: Our findings suggest that older adults with T1D have greater cognitive impairment than their peers without diabetes; findings were specific to the language and executive function domains, with episodic memory being unaffected. No increase in cognitive impairment was observed for older adults with T2D. Additional research is needed to understand the causes and potentially modifiable factors associated with impaired cognition among older adults with T1D.

Download Full-text

Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001173 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001173 ◽

Cited By ~ 1

Author(s):

Mary E Lacy ◽

Paola Gilsanz ◽

Chloe W Eng ◽

Michal S Beeri ◽

Andrew J Karter ◽

...

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Executive Function ◽

Cognitive Function ◽

Diabetic Ketoacidosis ◽

Brain Health ◽

Psychomotor Speed ◽

Logistic Regression Models ◽

Global Cognitive Function

IntroductionDiabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy in T1D, understanding the role of DKA on brain health in older adults is crucial.Research design and methodsWe examined the association of DKA with cognitive function in 714 older adults with T1D from the Study of Longevity in Diabetes. Participants self-reported lifetime exposure to DKA resulting in hospitalization; DKA was categorized into 0 hospitalization, 1 hospitalization or ≥2 hospitalizations (recurrent DKA). Global and domain-specific cognition (language, executive function/psychomotor speed, episodic memory and simple attention) were assessed. The association of DKA with cognitive function was evaluated via linear and logistic regression models.ResultsTwenty-eight percent of participants (mean age=67 years; mean age at diagnosis=28 years; average duration of diabetes=39 years) reported a lifetime history of DKA resulting in hospitalization (18.5% single DKA; 9.7% recurrent DKA). In fully adjusted models, those with recurrent DKA had lower global cognitive function (β=−0.13; 95% CI −0.22 to 0.02) and lower scores on the executive function/psychomotor speed domain (β=−0.34; 95% CI −0.51 to 0.17). Individuals with recurrent DKA were also more likely to have the lowest level of cognitive function on the executive function/psychomotor speed domain (defined as 1.5 SD below the population mean; OR=3.26, 95% CI 1.43 to 7.42).ConclusionsAmong 714 older adults with T1D, recurrent DKA was associated with lower global cognitive function, lower scores on the executive function/psychomotor speed domain and 3.3 times greater risk of having the lowest level of cognitive function in our sample on the executive function/psychomotor speed domain. These findings suggest that recurrent DKA may negatively impact the brain health of older patients with T1D and highlight the importance of DKA prevention.

Download Full-text