OBJECTIVE Hypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose level <3.0 mmol/L as “level 2 hypoglycemia.” In the current study we investigated whether having diabetes, type of diabetes, or hypoglycemia awareness moderates this association. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 ± 0.13 mmol/L [50.2 ± 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP). RESULTS For the whole group, hypoglycemia decreased the mean ± SD proportion of correct answers on the PASAT by 8.4 ± 12.8%, increased reaction time on the TAP Alertness task by 32.1 ± 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 ± 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA1c. CONCLUSIONS IHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia <3.0 mmol/L (<54 mg/dL) as being clinically relevant for most people with diabetes.

中文翻译：

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低血糖对糖尿病患者或非糖尿病患者认知功能的持续影响

目的 低血糖对认知功能构成直接威胁。由于与急性认知障碍有关，国际低血糖研究组 (IHSG) 将血糖水平 <3.0 mmol/L 定义为“2 级低血糖”。在当前的研究中，我们调查了糖尿病、糖尿病类型或低血糖意识是否会缓和这种关联。研究设) 接受了高胰岛素-正常血糖-低血糖葡萄糖钳夹 (2.80 ± 0.13 mmol/L [50.2 ± 2.3 mg/dL])。在基线和低血糖期间，计算能力、注意力、工作记忆和认知灵活性通过有节奏的听觉序列加法测试 (PASAT) 和注意力表现测试 (TAP) 进行测量。结果 对于整个组，低血糖使 PASAT 正确答案的平均 ± SD 比例降低了 8.4 ± 12.8%，对 TAP 警觉性任务的反应时间增加了 32.1 ± 66.6 ms，并增加了 TAP 错误和遗漏的总和工作记忆任务提高 2.0 ± 5.5（所有 P < 0.001）。低血糖引起的认知能力下降在很大程度上与糖尿病的存在或类型、症状意识水平、糖尿病持续时间或 HbA1c 无关。结论 IHSG 2 级低血糖会损害糖尿病患者和非糖尿病患者的认知功能，无论糖尿病类型或低血糖意识状态如何。这些发现支持低血糖的临界值和