**Acknowledgements**

Covariates that could affect neurocognitive testing and should be taken into account are, age, education, sex, history of other chronic illnesses, psychiatric and neurological disorders, absence from school, socioeconomic status, and hypo/hyperglycaemia during testing. Most of the studies control for at least some of these covariates, but most fail to control all of them [34]. There is wide criticism and controversies about low GI diet. Some authors state that is easy to follow and effective, whereas other authors think GI is highly variable, not physiological and difficult to learn and follow. Despite this, GI concept is accepted by many diabetes associations around the world as an integral part of the dietary treatment of diabetes. Despite the controversy, there is substantial evidence that a low GI diet can improve the GC in subjects with diabetes. It is vital to carry out further research of the role of GI in the prevention and treatment of diabetes and its complications together with beneficial effects of a low GI diet [17]. One of the major controversies about GI is that different studies state that the GI of food change in the presence of other macronutrients, but the reality is that GI is an intrinsic characteristic of food. Therefore, the GI of food does not change in the presence of other macronutrients, such as lipids, proteins and fibre, is just the glycaemic response. It has been shown that proteins induce greater insulin secretion, while fats reduce gastric emptying and slow down the absorption of carbohydrate. It is essential to study the effects of protein, fat and fibre on the glycaemic response to a carbohydrate meal [15], especially in children and adolescents. On the other hand, nutritional education and physical activity are essential in order to achieve a good GC of the disease. The main goal of diabetes management is to prevent long-term complications, not only cognitive dysfunction, also micro and macrovascular complications. More studies in cognitive function in diabetic children and adolescents with severe hypoglycaemia are needed, because preventing hypoglycaemia could reduce cognitive dysfunction [36], and improve healthy ageing in the diabetic patients. Long-term interventions will help also to know the impact of disease duration on cognition. More intensive diabetes medical regimes will be associated with less neurocognitive deficits, especially in patients with an EOD because they are more expose through time to glycaemic extremes (hypo and hyperglycaemias). It is vital to identify the factors that are involved in the aetiology and progression of the neurological complications, because currently the pathophysiology of cognitive dysfunction in diabetes is not well understood [1]. Therefore, it is important to understand the pathogenesis of cognitive dysfunction secondary to diabetes in order to establish more efficient treatments and prevent or reverse these cognitive alterations [34]. Thus, further well designed human studies are needed to elucidate the pathophysiology and the mechanisms of

action of cognitive dysfunction through neuroimaging [3].

diabetes and promote healthy ageing.

138 Diabetes Food Plan

In conclusion, it is necessary to carry out well designed long-term intervention randomised control trials with larger sample size, detailed cognitive assessment combined with neuroimaging [7] and adequate dietetic management. Furthermore, it is essential an early dietetic intervention in order to prevent or reduce diabetes-related complications, especially in children and adolescents with an EOD, because they are exposed through time to glycaemic extremes and are more vulnerable than adults, because their CNS is developing and any damage could be irreversible. Finally, it is important to identify population at risk during early life and childhood in order to develop clear recommendations, prevent the development of The authors of this chapter are participating in the DynaHEALTH project *'Understanding the dynamic determinants of glucose homeostasis and social capability to promote healthy and active aging'. European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 633595*.
