The Effects of Type 1 Diabetes on Cognitive Performance
A meta-analysis
Augustina M.A. Brands , MSC 1 2 3 ,
Geert Jan Biessels , PHD, MD 1 ,
Edward H.F. de Haan , PHD 1 3 ,
L. Jaap Kappelle , PHD, MD 1 and
Roy P.C. Kessels , PHD 1 3
1 Department of Neurology, University Medical Center, Utrecht, the Netherlands
2 Department of Neuropsychology, Hofpoort Hospital/Regional Psychiatrisch Centrum, Woerden, the Netherlands
3 Helmholtz Instituut, Utrecht University, the Netherlands
Address correspondence and reprint requests to Augustina M.A. Brands, MSc, Department of Neuropsychology, Hofpoort Hospital,
Blekerijlaan 3, 3447 AC Woerden, Netherlands. E-mail: i.brands{at}altrecht.nl
Abstract
OBJECTIVE —To investigate the exact nature and magnitude of cognitive impairments in patients with type 1 diabetes and the possible
association with other disease variables, such as recurrent episodes of hypoglycemia and metabolic control.
RESEARCH DESIGN AND METHODS —MedLine and PsycLit search engines were used to identify studies on cognitive performance in patients with type 1 diabetes.
Effect sizes (Cohen’s d ), which are the standardized differences between the experimental and the control group, were calculated. In the meta-analysis,
a combined d value was calculated, expressing the magnitude of associations across studies.
RESULTS —A total of 33 studies were identified that met the inclusion criteria. Compared with nondiabetic control subjects, the type
1 diabetic group demonstrated a significantly lowered performance on the following cognitive domains: intelligence ( d = −0.7), speed of information processing ( d = −0.3), psychomotor efficiency ( d = −0.6), visual ( d = −0.4) and sustained attention ( d = −0.3), cognitive flexibility ( d = −0.5), and visual perception ( d = −0.4). Lowered cognitive performance in diabetic patients appeared to be associated with the presence of microvascular
complications but not with the occurrence of severe hypoglycemic episodes or with poor metabolic control.
CONCLUSIONS —In patients with type 1 diabetes, cognitive dysfunction is characterized by a slowing of mental speed and a diminished mental
flexibility, whereas learning and memory are spared.The magnitude of the cognitive deficits is mild to moderate, but even
mild forms of cognitive dysfunction might hamper everyday activities since they can be expected to present problems in more
demanding situations.
Footnotes
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org .
Accepted December 9, 2004.
Received October 5, 2004.
DIABETES CARE...

The Effects of Type 1 Diabetes on Cognitive Performance

10.2337/diacare.28.3.726