Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
e-Letters: Comments and Responses

Comment on Nunley et al. Clinically Relevant Cognitive Impairment in Middle-Aged Adults With Childhood-Onset Type 1 Diabetes. Diabetes Care 2015;38:1768–1776

  1. Kiki van Broekhoven and
  2. Giesje Nefs⇑
  1. Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
  1. Corresponding author: Giesje Nefs, g.m.nefs{at}tilburguniversity.edu.
Diabetes Care 2016 Feb; 39(2): e24-e24. https://doi.org/10.2337/dc15-2163
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Nunley et al. (1) examined the presence and correlates of clinically relevant cognitive impairment in middle-aged adults with childhood-onset type 1 diabetes as compared with adults without type 1 diabetes. The authors concluded that the prevalence of cognitive impairment was five times higher in adults with type 1 diabetes as compared with participants without type 1 diabetes (28% vs. 5%), independent of age, education, or blood pressure. Diabetes-specific factors related to cognitive impairment were chronic hyperglycemia and prevalent microvascular disease.

While the current study provides us with important insights regarding cognitive impairment in adults with type 1 diabetes, we regret that depression has not been taken into account. A systematic review and meta-analysis published in 2014 identified significant objective cognitive impairment in adults and adolescents with depression regarding executive functioning, memory, and attention relative to control subjects (2). Moreover, depression is two times more common in adults with diabetes compared with those without this condition, regardless of type of diabetes (3). There is even evidence that the co-occurrence of diabetes and depression leads to additional health risks such as increased mortality and dementia (3,4); this might well apply to cognitive impairment as well. Furthermore, in people with diabetes, the presence of depression has been associated with the development of diabetes complications, such as retinopathy, and higher HbA1c values (3). These are exactly the diabetes-specific correlates that Nunley et al. (1) found.

We believe it is a missed opportunity that Nunley et al. (1) mainly focused on biological variables, such as hyperglycemia and microvascular disease, and did not take into account an emotional disorder widely represented among people with diabetes and closely linked to cognitive impairment. Even though severe or chronic cases of depression are likely to have been excluded in the group without type 1 diabetes based on exclusion criteria (1), data on the presence of depression (either measured through a diagnostic interview or by using a validated screening questionnaire) could have helped to interpret the present findings.

Determining the role of depression in the relationship between cognitive impairment and type 1 diabetes is of significant importance. Treatment of depression might improve cognitive impairment both directly by alleviating cognitive depression symptoms and indirectly by improving treatment nonadherence and glycemic control, consequently lowering the risk of developing complications. With regard to depression in people with diabetes, we wish to conclude, in line with van der Feltz-Cornelis et al. (5), that improvement of the general medical condition would ideally focus on both conditions simultaneously.

Article Information

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

  • © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

References

  1. ↵
    1. Nunley KA,
    2. Rosano C,
    3. Ryan CM, et al
    . Clinically relevant cognitive impairment in middle-aged adults with childhood-onset type 1 diabetes. Diabetes Care 2015;38:1768–1776
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Rock PL,
    2. Roiser JP,
    3. Riedel WJ,
    4. Blackwell AD
    . Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 2014;44:2029–2040
    OpenUrlCrossRefPubMed
  3. ↵
    1. Pouwer F,
    2. Nefs G,
    3. Nouwen A
    . Adverse effects of depression on glycemic control and health outcomes in people with diabetes: a review. Endocrinol Metab Clin North Am 2013;42:529–544
    OpenUrlCrossRefPubMed
  4. ↵
    1. Katon W,
    2. Pedersen HS,
    3. Ribe AR, et al
    . Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study. JAMA Psychiatry 2015;72:612–619
    OpenUrlCrossRefPubMed
  5. ↵
    1. van der Feltz-Cornelis CM,
    2. Nuyen J,
    3. Stoop C, et al
    . Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry 2010;32:380–395
    OpenUrlCrossRefPubMedWeb of Science
PreviousNext
Back to top
Diabetes Care: 39 (2)

In this Issue

February 2016, 39(2)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Comment on Nunley et al. Clinically Relevant Cognitive Impairment in Middle-Aged Adults With Childhood-Onset Type 1 Diabetes. Diabetes Care 2015;38:1768–1776
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Comment on Nunley et al. Clinically Relevant Cognitive Impairment in Middle-Aged Adults With Childhood-Onset Type 1 Diabetes. Diabetes Care 2015;38:1768–1776
Kiki van Broekhoven, Giesje Nefs
Diabetes Care Feb 2016, 39 (2) e24; DOI: 10.2337/dc15-2163

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Comment on Nunley et al. Clinically Relevant Cognitive Impairment in Middle-Aged Adults With Childhood-Onset Type 1 Diabetes. Diabetes Care 2015;38:1768–1776
Kiki van Broekhoven, Giesje Nefs
Diabetes Care Feb 2016, 39 (2) e24; DOI: 10.2337/dc15-2163
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Article Information
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Response to Comment on Herring et al. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020;43:2128–2136
  • Comment on Herring et al. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020;43:2128–2136
  • Comment on Zhou et al. Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review. Diabetes Care 2020;43:1593–1616
Show more e-Letters: Comments and Responses

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.