Glycemic Control and Hypoglycemia: Is the Loser the Winner?
Response to Perlmuter et al.
- Gail Musen, PHD1,2,
- Alan M. Jacobson, MD1,2,
- Christopher M. Ryan, PHD3,
- Patricia A. Cleary, MS4,
- Barbara H. Waberski, MS4,
- Katie Weinger, EDD1,2,
- William Dahms, MD5,†,
- Meg Bayless, RN6,
- Nancy Silvers, RN3,
- Judith Harth, RN7 and
- Neil White, MD, CDE8
- 1Joslin Diabetes Center, Boston, Massachusetts;
- 2Department of Psychiatry, Harvard Medical School, Boston, Massachusetts;
- 3Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
- 4Biostatistics Center, George Washington University, Washington, D.C.;
- 5Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio;
- 6Diabetes Clinical Research & Programs, University of Iowa, Iowa City, Iowa;
- 7St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada;
- 8Department of Pediatric Endocrinology and Metabolism, Washington University in St. Louis, St. Louis, Missouri.
- Corresponding author: Gail Musen, gail.musen{at}joslin.harvard.edu.
The editorial by Perlmuter et al. (1) in the October 2008 issue of Diabetes Care commented on the long-term effects of severe hypoglycemia and raised concerns about our study (2), which reported that within the cohort of subjects who entered the Diabetes Control and Complications Trial (DCCT) during adolescence, there was no relationship between subsequent episodes of severe hypoglycemia and cognitive performance measured ∼20 years after study entry. Below, we outline their five major concerns and provide supporting information.
One concern of Perlmuter et al. was the exclusion of potential participants from the DCCT if they had a history of severe hypoglycemia, thus limiting generalizability. However, a history of severe hypoglycemia was not an absolute exclusion criterion for participation in the DCCT. Indeed, 24% of the 175 participants had previously experienced 1–5 episodes of severe hypoglycemia with loss of consciousness before entry …
