Background: Diabetic ketoacidosis (DKA) is a life-threatening complication common in type 1 diabetes (T1D). DKA is associated with short-term cognitive impairment in children and adolescents with T1D, but it is unknown if a lifetime history of DKA is associated with poorer cognition in older adults.

Methods: We examined the association between self-reported frequency of lifetime DKA hospitalizations and cognition in 720 older adults with T1D from the Study of Longevity in Diabetes (SOLID). Cognitive tests assessed 4 cognitive domains identified via factor analysis (language, executive function, episodic memory, attention). We examined: 1) the association between DKA and cognitive domains using adjusted linear regression; and 2) frequency of cognitive impairment (1.5 SD below mean) by DKA exposure.

Results: Overall, 28% of participants reported DKA resulting in hospitalization in their lifetime (18% had 1 hospitalization; 10% had 2+ hospitalizations). Compared to those with no DKA hospitalizations, those with 2+ had lower executive function scores and were more likely to have impaired executive function. Language, episodic memory and simple attention did not differ by DKA.

Conclusions: In older adults with T1D, lifetime exposure to DKA is associated with long-term impairment in cognition, specifically through executive function.

M.E.L. Leigh: None. P. Gilsanz: None. M.S. Beeri: None. A.J. Karter: None. C. Quesenberry: None. R.A. Whitmer: None.


National Institutes of Health (R01AG047500, T32AG049663, R01DK103721, R01DK081796, P30DK092924); Patient-Centered Outcomes Research Institute (PPRN-1306-04709)

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