Last updated May 16, 2026
Key finding
In 11 people with type 1 diabetes prone to severe low blood sugar, a single high dose of erythropoietin improved performance on a complex attention task during experimentally induced hypoglycemia, but didn't affect other cognitive tests or hypoglycemia symptoms.
This small study tested whether erythropoietin (EPO), a hormone known to protect brain cells, could help preserve mental function during low blood sugar episodes in people with type 1 diabetes. Eleven participants received either EPO or placebo before undergoing controlled hypoglycemia. EPO improved performance on one specific attention task but didn't help with other mental tests or reduce symptoms.
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EvidenceScore™
Low
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Short-Term (≤3 mo)
Risk of bias
Some Concerns
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Study focus
In 11 people with type 1 diabetes prone to severe low blood sugar, a single high dose of erythropoietin improved performance on a complex attention task during experimentally induced hypoglycemia, but didn't affect other cognitive tests or hypoglycemia symptoms.
Published in
Publication details and source links for this paper.
Kristensen PL, Pedersen-Bjergaard U, Kjær TW, et al. Influence of Erythropoietin on Cognitive Performance during Experimental Hypoglycemia in Patients with Type 1 Diabetes Mellitus: A Randomized Cross-Over Trial. PLoS ONE. 2013;8(4):e59672. doi:10.1371/journal.pone.0059672
Reaction time in complex attention task ↓ (66 milliseconds faster)
Errors in complex attention task ↓ (4.7 fewer errors)
Hypoglycemia symptoms → (no change)
Evidence network
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This study contributes evidence to Erythropoietin and Complex reaction time (sustained attention task).
This study contributes evidence to
Primary intervention
Erythropoietin
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16
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The primary outcomes reported in this study.
Erythropoietin → Complex reaction time (sustained attention task)
Erythropoietin → Complex reaction time (sustained attention task)
Evidence Library
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Adults with type 1 diabetes who experience hypoglycemia unawareness and recurrent severe hypoglycemia (2 or more episodes per year). Study participants had long-standing diabetes (median 29 years duration), used insulin therapy, and had HbA1c levels around 7.6%. Results may be most relevant for individuals at high risk of severe hypoglycemia where cognitive protection during episodes could be clinically meaningful.
The benefit was seen in only one out of multiple cognitive tests, and the study was very small with just 11 participants. Regular EPO treatment is not safe for people with diabetes because it increases red blood cell production, raising risks of blood clots, stroke, and high blood pressure. The findings are mainly useful for developing safer, modified versions of EPO that protect brain cells without affecting blood cells. The study used experimental hypoglycemia in a controlled setting, which may differ from real-world low blood sugar episodes. Most participants had decades of diabetes and impaired hypoglycemia awareness, so results may not apply to people with different diabetes characteristics or those who can still sense their low blood sugar.
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on DPP-4 Inhibitors and Cognitive Performance.
This study contributes to the evidence on the following intervention-outcome relationships.
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1 results
1 results
1 results
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Current evidence does not show a clear benefit of DPP-4 Inhibitors for Cognitive Performance.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Complex reaction time (sustained attention task)
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
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