Metabolic brain adaptations to recurrent hypoglycaemia may explain the link between type 1 diabetes mellitus and epilepsy and point towards future study and treatment options

Excerpt

To the Editor: We read the retrospective study by Dafoulas, Toulis et al [1] on the association between type 1 diabetes and risk of epilepsy with great interest. In their article, the authors reported that individuals with type 1 diabetes are at approximately three-times greater risk of developing epilepsy compared with age- and sex-matched controls without type 1 diabetes. This finding, based on the data obtained from a large cohort of 24,610 individuals followed for a mean of 5.4 years, is robust and consistent with a recent study by Chou et al [2], also published in Diabetologia. Although the results of both studies may have substantial clinical implications, a better understanding of the causative mechanisms linking the two conditions will be essential to ultimately translate these findings into daily clinical practice. Potential mechanisms suggested by the authors include ‘genetic or shared autoimmune factors’ or ‘cerebrovascular damage resulting from metabolic abnormalities’ [1]. These factors are clearly good candidates for explaining the association between type 1 diabetes and epilepsy. Nonetheless, several additional key mechanisms that are linked to the incidence of recurrent hypoglycaemia (the most frequent complication of intensive insulin therapy in type 1 diabetes) might also contribute to this association. …