***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ninety-seven patients with insulin dependent diabetes mellitus ( IDDM ) were r and omized to intensified conventional treatment ( ICT , n = 44 ) or regular treatment ( RT , n = 53 ) . The mean HbA1c level ( + /- SEM ) was reduced from 9.5 + /- 0.2 % to 7.4 + /- 0.1 % in the ICT group ( P less than 0.001 ) , and from 9.4 + /- 0.2 % to 9.0 + /- 0.2 % ( P less than 0.01 ) in the RT group . The difference between the groups was significant ( P less than 0.001 ) . During a period of 3 years , 57 % of the ICT patients ( 95 % confidence interval 44 - 73 % ) and 23 % of the RT patients ( 95 % CI , 11 - 34 % ) ( P less than 0.001 ) had at least one episode of serious hypoglycaemia , with the need for third-party assistance or result ing in coma . Eighteen of the 32 ICT patients who initially had adrenergic symptoms during hypoglycaemia changed to predominantly neuroglycopenic symptoms . This was the case with only 8 of 38 RT patients ( P less than 0.01 ) . The change in symptoms was related to the increased frequency of serious hypoglycaemia , but neither symptoms nor frequency of hypoglycaemia bor any relationship to insulin dose , body mass index , duration of diabetes or autonomic nerve function . The results of several neuropsychological tests did not differ between the groups at baseline , and did not change during the study . There were no signs of deteriorating cognitive function in the patients with serious hypoglycaemic episodes OBJECTIVE —In this study , we used neurocognitive assessment and neuroimaging to examine brain function in youth with type 1 diabetes studied prospect ively from diagnosis . RESEARCH DESIGN AND METHODS —We studied type 1 diabetic ( n = 106 ) and control subjects ( n = 75 ) with no significant group difference on IQ at baseline 12 years previously by using the Wechsler Abbreviated Scale of General Intelligence , magnetic resonance spectroscopy and imaging , and metabolic control data from diagnosis . RESULTS —Type 1 diabetic subjects had lower verbal and full scale IQs than control subjects ( both P < 0.05 ) . Type 1 diabetic subjects had lower N-acetylaspartate in frontal lobes and basal ganglia and higher myoinositol and choline in frontal and temporal lobes and basal ganglia than control subjects ( all P < 0.05 ) . Type 1 diabetic subjects , relative to control subjects , had decreased gray matter in bilateral thalami and right parahippocampal gyrus and insular cortex . White matter was decreased in bilateral parahippocampi , left temporal lobe , and middle frontal area ( all P < 0.0005 uncorrected ) . T2 in type 1 diabetic subjects was increased in left superior temporal gyrus and decreased in bilateral lentiform nuclei , cau date nuclei and thalami , and right insular area ( all P < 0.0005 uncorrected ) . Early-onset disease predicted lower performance IQ , and hypoglycemia was associated with lower verbal IQ and volume reduction in thalamus ; poor metabolic control predicted elevated myoinositol and decreased T2 in thalamus ; and older age predicted volume loss and T2 change in basal ganglia . CONCLUSIONS —This study documents brain effects 12 years after diagnosis in a type 1 diabetic sample whose IQ at diagnosis matched that of control subjects . Findings suggest several neuropathological processes including gliosis , demyelination , and altered osmolarity Background Prospect i ve memory is that memory which is required to carry out intended actions and is therefore essential in carrying out the daily activities required in the self-management of type 1 diabetes mellitus ( T1DM ) . This study aim ed to identify the relationships between prospect i ve memory and diabetic control in children with T1DM . Method 94 children aged 6–18 years with T1DM completed an innovative prospect i ve memory screen , PROMS , and a series of cognitive tests . Parents answered question naires about their children 's diabetic histories and cognitive skills . Results No association between total PROMS score and glycemic control was found . Lower HbA1C was associated with higher ( better ) scores on the 20 minute event-based task on the PROMS . Parental concerns about working memory and metacognition in their children were mirrored by higher HbA1C . Conclusions This study suggests that there may be an association between glycemic control and prospect i ve memory for event based tasks . Additional studies need to be done to determine reproducibility , causality , and if prospect i ve memory based interventions can improve diabetic control Declining incidences in Europe of overt nephropathy , proliferative retinopathy , and mortality in type 1 diabetes have recently been reported . However , comparable data for the U.S. and trend data for neuropathy and macrovascular complications are lacking . These issues are addressed using the prospect i ve observational Pittsburgh Epidemiology of Childhood-Onset Diabetes Complications Study . Participants were stratified into five cohorts by diagnosis year : 1950–1959 , 1960–1964 , 1965–1969 , 1970–1974 , and 1975–1980 . Mortality , renal failure , and coronary artery disease ( CAD ) status were determined on the complete cohort ( n = 906 ) at 20 , 25 , and 30 years . Overt nephropathy , proliferative retinopathy , and neuropathy were assessed at 20 and 25 years on the subset of participants with a clinical examination . There was a decreasing trend by diagnosis year for mortality , renal failure , and neuropathy across all time intervals ( P < 0.05 ) , with the 1950–1959 cohort having a fivefold higher mortality at 25 years than the 1970s ’ cohorts . Proliferative retinopathy and overt nephropathy showed nonsignificant declines at 20 years ( P < 0.16 and P < 0.13 , respectively ) and no change at 25 years . CAD event rates , which were lower than the other complications , also showed no trend . Although some type 1 diabetes complications ( mortality , renal failure , and neuropathy ) are declining , others ( CAD , overt nephropathy , and proliferative retinopathy ) show less favorable changes by 30 years OBJECTIVE —The purpose of this study was to evaluate whether severe hypoglycemia or intensive therapy affects cognitive performance over time in a subgroup of patients who were aged 13–19 years at entry in the Diabetes Control and Complications Trial ( DCCT ) . RESEARCH DESIGN AND METHODS —This was a longitudinal study involving 249 patients with type 1 diabetes who were between 13 and 19 years old when they were r and omly assigned in the DCCT .  Scores on a comprehensive battery of cognitive tests obtained during the Epidemiology of Diabetes Interventions and Complications follow-up study , ∼18 years later , were compared with baseline performance . We assessed the effects of the original DCCT treatment group assignment , mean A1C values , and frequency of severe hypoglycemic events on eight domains of cognition . RESULTS —There were a total of 294 reported episodes of coma or seizure . Neither frequency of hypoglycemia nor previous treatment group was associated with decline on any cognitive domain . As in a previous analysis of the entire study cohort , higher A1C values were associated with declines in the psychomotor and mental efficiency domain ( P < 0.01 ) ; however , the previous finding of improved motor speed with lower A1C values was not replicated in this subgroup analysis . CONCLUSIONS —Despite relatively high rates of severe hypoglycemia , cognitive function did not decline over an extended period of time in the youngest cohort of patients with type 1 diabetes BACKGROUND Lowered neuropsychological performance is evident in youth with type 1 diabetes , although evidence for associations with specific illness variables is inconsistent . This study examined the neuropsychological profiles of a cohort of youth with type 1 diabetes studied prospect ively from diagnosis 12 yr previously . METHODS A total of 106 youth with type 1 diabetes and 75 healthy controls participated . There were no significant group differences on Full-scale IQ assessed on study entry 12 yr previously , current socioeconomic status , gender distribution , or age . Neuropsychological tests assessed eight cognitive domains : verbal abilities , perceptual reasoning , new learning , working memory , non-verbal processing speed , mental efficiency , divided attention , and sustained attention . Episodes of serious hypoglycemia and HbA(1c ) levels were recorded from diagnosis . RESULTS Youth with type 1 diabetes performed more poorly than controls on working memory ( p < .05 ) . Early onset diabetes was related to poorer sustained ( p < .001 ) and divided attention ( p = .001 ) , new learning , and mental efficiency ( both p < .05 ) . Hypoglycemia was found to adversely effect verbal abilities , working memory , and non-verbal processing speed ( all p < .05 ) . Poorer working memory was associated with hyperglycemia ( p < .05 ) . Youth with any combination of two or three illness risk factors ( i.e. , early onset diabetes , hypo- , hyperglycemia ) , performed more poorly than controls and youth with no or one risk on verbal abilities , working memory , and mental efficiency . CONCLUSIONS This study documents poorer neuropsychological performance and its association with illness risk factors in youth with type 1 diabetes . Findings suggest that early disease onset and hypoglycemia impact on the developing central nervous system , with hyperglycemia playing a lesser role Abstract . Aims /hypothesis : Good metabolic control in diabetic children is already crucial before puberty to prevent diabetic complications later in life . However , tight metabolic control could increase the risk of severe hypoglycaemia , which might be responsible for impaired intellectual performance later in life . The purpose of this prospect i ve longitudinal study was to evaluate the relevance of long-term metabolic control and hypoglycaemia possibly affecting the intellectual development of young children with Type I ( insulin-dependent ) diabetes mellitus . Methods : The intellectual development in 64 diabetic children between the ages of 7 and 16 years was assessed at least four times using the German version of the Hamburg Wechsler intelligence scale for preschool children , Children-Revised and by the “ Adaptives Intelligenz Diagnostikum ” ( Adaptive Intelligence Diagnosticum ) . Data were analysed longitudinally compared with a control group . Results : A significant decline in performance by age 7 and in verbal intelligence quotient between age 7 and 16 years was observed in diabetic boys diagnosed before the age of 6 but not in those diagnosed later and not in diabetic girls . The deterioration of intellectual performance in boys diagnosed at a very young age was not associated with the occurrence of severe hypoglycaemic episodes but was correlated with the degree of metabolic deterioration at diagnosis and with high long-term average of glycated haemoglobin . Conclusion /interpretation : Our study in diabetic children shows that the male sex , diagnosis at a young age , metabolic condition at diagnosis and long-term metabolic control , rather than experienced hypoglycaemic attacks are risk factors for intellectual development . [ Diabetologia ( 2002 ) 45 : 108–114 OBJECTIVE This study examined illness-related change in intelligence quotient ( IQ ) in a cohort of youth with type 1 diabetes studied prospect ively from disease onset in childhood to follow-up 12 years later in late adolescence/early adulthood . RESEARCH DESIGN AND METHODS Participants included type 1 diabetes patients ( n = 95 ; mean age at follow-up 21.3 years ) and healthy control participants ( HCs ; n = 67 ; mean age at follow-up 21.0 years ) from a cohort followed prospect ively . Measures included Wechsler Preschool and Primary Scale of Intelligence-Revised , Wechsler Intelligence Scale for Children-Revised , and Wechsler Abbreviated Scale of Intelligence and prospect i ve collection of data on metabolic control history . RESULTS Young people with type 1 diabetes showed greater decline in verbal IQ ( VIQ ) and full-scale IQ ( FSIQ ) , but not performance IQ ( PIQ ) , than HCs . Within the diabetes group , a younger age at diabetes onset was associated with a decline in PIQ and FSIQ ( P ≤ 0.001 ) . A history of hypoglycemic seizures was associated with a decline in VIQ ( P = 0.002 ) . Long-term metabolic control was not associated with changes in IQ . Interaction terms were not significant , suggesting no moderating effect of one diabetes-related variable over another . CONCLUSIONS The presence of diabetes may negatively influence some aspects of IQ over time . Specific illness risk factors , such as an earlier age of disease onset and a history of hypoglycemic seizures , appear to put the young person at greater risk . Academic progress of children identified as at risk should be monitored and educational supports provided if necessary OBJECTIVE Acute hypoglycemia in humans impairs cognitive functions and alters mood states . The time required for cognitive functions and moods to return to normal after an acute episode of severe hypoglycemia 
    Output:
    
SH in early childhood-onset diabetes , especially seizures and coma , was associated with poorer memory ( verbal and visuospatial ) , as well as verbal intelligence .
Among adult-onset diabetes , SH was associated with poorer cognitive performance in the older age ( > 55 years ) group only .
Early versus late exposure to SH had a significant association with cognitive dysfunction ( CD ) .
NSH and NH did not have any significant association with CD , while impaired awareness of hypoglycaemia was associated with poorer memory and cognitive-processing speeds .
Conclusion The effect of SH on cognitive function is age dependent .