title: Intensified conventional insulin treatment and neuropsychological impairment.
abstract: OBJECTIVE
  To assess whether intensified insulin treatment, with an increased frequency of hypoglycaemic episodes, leads to cognitive deterioration.
  
  
  METHODS
  Prospective randomised trial of intensified conventional treatment and standard treatment.
  
  
  METHODS
  Outpatient clinic for patients with insulin dependent diabetes.
  
  
  METHODS
  96 patients with insulin dependent diabetes, high blood glucose concentrations, and non-proliferative retinopathy were randomised to intensified conventional treatment (n = 44) or standard treatment (n = 52).
  
  
  METHODS
  Glycated haemoglobin concentration (metabolic control); the number of hypoglycaemic episodes reported by patients at each visit; results of computerised neuropsychological tests performed at entry and after five years.
  
  
  RESULTS
  Mean glycated haemoglobin concentration during the study was 7.2% (SE 0.1%) with intensified conventional treatment and 8.7 (0.1%) with standard treatment (p less than 0.001). During five years 34 (77%, 95% confidence interval 53% to 100%) of the patients given intensified treatment and 29 (56%, 36% to 75%) of the others had at least one episode of serious hypoglycaemia (p less than 0.05). The intensified conventional treatment group had a mean of 1.1 episodes of serious hypoglycaemia per patient per year compared with 0.4 episodes in the standard treatment group. Results of the neuropsychological tests were similar in the two groups after five years.
  
  
  CONCLUSIONS
  Intensified conventional insulin treatment led to lower blood glucose concentrations and a higher frequency of hypoglycaemic episodes, but patients showed no signs of cognitive deterioration.
authors.affiliation: Department of Internal Medicine II, Södersjukhuset, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Reichard
authors.forename: A
authors.initials: A
authors.lastname: Britz
authors.forename: U
authors.initials: U
authors.lastname: Rosenqvist
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000150:complications*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009431:Neural Conduction / Q000502:physiology; D011446:Prospective Studies
chemical_list: D007328:Insulin