Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

J Z Petersen; Malin Nilsson; J Rungby; K W Miskowiak

doi:10.1016/j.psyneuen.2019.104431

Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

J Z Petersen, Malin Nilsson, J Rungby, K W Miskowiak

Department of Clinical Medicine

1 Citation (Scopus)

Abstract

Background: Acute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients’ expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia. Objective: This report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia. Methods: We performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients’ expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global ‘cognitive discrepancy’ composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed). Results: Patients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = −1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. Underestimation of cognitive capacity during hypoglycaemia was more pronounced for patients with younger age (β = 0.5, p = 0.02), higher verbal IQ (β = 0.5, p = 0.03), and more hypoglycaemia-related shakiness (β = 0.4, p = 0.03). Limitations: The modest sample size limits the generalizability of the findings. Conclusions: Patients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.

Original language	English
Journal	Psychoneuroendocrinology
Volume	110
Pages (from-to)	104431
ISSN	0306-4530
DOIs	https://doi.org/10.1016/j.psyneuen.2019.104431
Publication status	Published - Dec 2019

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10.1016/j.psyneuen.2019.104431

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@article{81ea149ea1c74d19976af025493cb6d1,

title = "Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes",

abstract = "Background: Acute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients{\textquoteright} expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia. Objective: This report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia. Methods: We performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients{\textquoteright} expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global {\textquoteleft}cognitive discrepancy{\textquoteright} composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed). Results: Patients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = −1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. Underestimation of cognitive capacity during hypoglycaemia was more pronounced for patients with younger age (β = 0.5, p = 0.02), higher verbal IQ (β = 0.5, p = 0.03), and more hypoglycaemia-related shakiness (β = 0.4, p = 0.03). Limitations: The modest sample size limits the generalizability of the findings. Conclusions: Patients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.",

author = "Petersen, {J Z} and Malin Nilsson and J Rungby and Miskowiak, {K W}",

year = "2019",

month = dec,

doi = "10.1016/j.psyneuen.2019.104431",

language = "English",

volume = "110",

pages = "104431",

journal = "Psychoneuroendocrinology",

issn = "0306-4530",

publisher = "Pergamon Press",

}

TY - JOUR

T1 - Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

AU - Petersen, J Z

AU - Nilsson, Malin

AU - Rungby, J

AU - Miskowiak, K W

PY - 2019/12

Y1 - 2019/12

N2 - Background: Acute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients’ expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia. Objective: This report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia. Methods: We performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients’ expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global ‘cognitive discrepancy’ composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed). Results: Patients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = −1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. Underestimation of cognitive capacity during hypoglycaemia was more pronounced for patients with younger age (β = 0.5, p = 0.02), higher verbal IQ (β = 0.5, p = 0.03), and more hypoglycaemia-related shakiness (β = 0.4, p = 0.03). Limitations: The modest sample size limits the generalizability of the findings. Conclusions: Patients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.

AB - Background: Acute hypoglycaemia is associated with cognitive impairment in patients with type 2 diabetes. However, there is limited understanding of the relationship between patients’ expected cognitive difficulties and their objectively-measured deficits during non-severe hypoglycaemia. Objective: This report investigates demographic and clinical factors associated with the discrepancy between expected (i.e., self-evaluated) and measurable (i.e., neuropsychological) cognitive functions in patients with type 2 diabetes during acute non-severe hypoglycaemia. Methods: We performed an analysis of factors associated with the relationship between expected and measurable cognitive performance for data collected from a cohort of patients with type 2 diabetes (N = 25). Patients attended two experimental visits during which we performed hyper-insulinaemic glucose clamping; (i) non-severe hypoglycaemic clamp (plasma glucose (PG): 3.1 ± 0.3 mmol/L) and (ii) normoglycaemic clamp (PG: 5.8 ± 0.3 mmol/L), as part of a double-blinded cross-over study. During hypoglycaemia, patients’ expected cognitive performance was assessed with a visual analogue scale after which objective cognitive functions were assessed with a neuropsychological test battery. We computed a global ‘cognitive discrepancy’ composite variable with score values on a scale between -10 and +10 using a novel statistical formula that creates a discrepancy score between subjective and objective cognition. Positive values reflect more expected than objectively-measured difficulties, while negative values reflect disproportionately more objectively-measured than expected cognitive difficulties. We used paired samples t-tests to compare degree of cognitive discrepancy between conditions of hypo- and normoglycaemia, while multiple regression analysis was performed to identify factors associated with the degree and direction of the cognitive discrepancy. The significance level for the analyses was p ≤ 0.05 (two-tailed). Results: Patients generally underestimated their cognitive abilities (M = 1.6, SD = 3.3) during hypoglycaemia compared to normoglycaemia (M = −1.0, SD = 3.5) (p = 0.2), t(23) = 2.9, p < 0.01. Underestimation of cognitive capacity during hypoglycaemia was more pronounced for patients with younger age (β = 0.5, p = 0.02), higher verbal IQ (β = 0.5, p = 0.03), and more hypoglycaemia-related shakiness (β = 0.4, p = 0.03). Limitations: The modest sample size limits the generalizability of the findings. Conclusions: Patients with type 2 diabetes underestimated their cognitive abilities during non-severe hypoglycaemic states, especially those with younger age, higher IQ, and more hypoglycaemia-related shakiness. These patients may thus have excessive preoccupations with their cognitive difficulties in relation to cognitively challenging daily life situations.

U2 - 10.1016/j.psyneuen.2019.104431

DO - 10.1016/j.psyneuen.2019.104431

M3 - Journal article

C2 - 31536941

SN - 0306-4530

VL - 110

SP - 104431

JO - Psychoneuroendocrinology

JF - Psychoneuroendocrinology

ER -

Characteristics influencing expected cognitive performance during hypoglycaemia in type 2 diabetes

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