{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:16:45Z","timestamp":1783012605390,"version":"3.54.6"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study evaluated the impact of selected clinical factors on cognitive impairment (CI), particularly diabetic peripheral neuropathy (DPN) and impaired awareness of hypoglycaemia (IAH) in individuals with long\u2010standing type 1 diabetes (T1D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional Hypoglycaemia Awareness Study in Diabetes Type 1 (HAD\u20101), 252 adults with T1D were enrolled. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with CI defined as a MoCA score &lt;\u00a026. IAH was identified using validated questionnaires (Clarke scale, Gold scale and Hypoglycaemia Awareness Questionnaire).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median MoCA score was 26 (23\u201328). CI was present in 122 subjects (48%), DPN in 85 subjects (34%) and IAH in 98 patients (39%). In univariate linear regression analysis, lower MoCA scores were associated with higher HbA1c (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.30 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.017), older age (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.03 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.014), a greater number of lifetime severe hypoglycaemia (SH) episodes (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.17 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), DPN (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22121.09 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01) and higher skin autofluorescence (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.72 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). In the multivariable regression analysis, IAH (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22121.41 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), male sex (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.89 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.022), higher HbA1c (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.47 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and higher vibration perception threshold (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.049 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.004) were independent predictors of lower cognitive performance. Higher insulin dose (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0+2.92 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.012) was independently associated with better cognitive performance. In the interaction model, IAH (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22121.54 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003) and DPN (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22121.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.040) were independently associated with approximately 1.2\u20131.5\u2010point lower MoCA scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In individuals with T1D, DPN and IAH, a history of SH, poorer metabolic control, older age and male sex are associated with CI. People with T1D should be screened for CI, especially if they have DPN or IAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.70180","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T14:04:47Z","timestamp":1778940287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Metabolic Predictors of Cognitive Impairment in Type 1 Diabetes: The Role of Peripheral Neuropathy and Hypoglycaemia Unawareness. Findings From a HAD\u20101 Study"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-5179","authenticated-orcid":false,"given":"Magdalena","family":"Michalak","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Diabetology Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2995-9971","authenticated-orcid":false,"given":"Dorota","family":"Zozuli\u0144ska\u2010Zi\u00f3\u0142kiewicz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Diabetology Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2852-3984","authenticated-orcid":false,"given":"Micha\u0142","family":"Michalak","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Statistics Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justyna","family":"Floty\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Diabetology Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Cieluch","sequence":"additional","affiliation":[{"name":"Vital Medical Centre  Slawsk Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Michalski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Diabetology Poznan University of Medical Sciences  Poznan Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4955-6099","authenticated-orcid":false,"given":"Aleksandra","family":"Araszkiewicz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Diabetology Poznan University of 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