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The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus (DM) patients with episodes of recurrent severe hypoglycemia,by using meta-analysis to synthesize data across studies.PubMed,EMBASE and Cochrane library search engines were used to identify studies on cognitive performance in DM patients with recurrent severe hypoglycemia.Random-effects meta-analysis was performed on seven eligible studies using an inverse-variance method.Effect sizes,which are the standardized differences between the experimental group and the control group,were calculated.Of the 853 studies,7 studies met the inclusion criteria.Compared with control subjects,the adult DM patients with episodes of recurrent severe hypoglycemia demonstrated a significantly lowered performance on memory in both types of DM patients,and poor performance of processing speed in type 2 DM patients.There was no significant difference between adult DM patients with and those without severe hypoglycemia in other cognitive domains such as general intelligence,executive function,processing speed and psychomotor efficiency.Our results seem to confirm the hypothesis that cognitive dysfunction is characterized by worse memory and processing speed in adult DM patients with a history of recurrent severe hypoglycemia,whereas general intelligence,executive function,and psychomotor efficiency are spared.