AbstractIntroductionPrevious studies suggest that cognitive impairment is more prevalent in individuals with painful and painless diabetic peripheral neuropathy (DPN). However, the current evidence is not well described. This study investigated cognitive function in adults with type 1 diabetes mellitus (T1DM) and the association to painful/painless DPN and clinical parameters.MethodsThis cross‐sectional, observational, case–control study included 58 participants with T1DM, sub‐grouped into 20 participants with T1DM and painful DPN, 19 participants with T1DM and painless DPN, 19 participants with T1DM without DPN, and 20 healthy controls were included. The groups were matched for sex and age. The participants performed Addenbrooke's examination III (ACE‐III), which assesses attention, memory, verbal fluency, language and visuospatial skills. Working memory was evaluated using an N‐back task. Cognitive scores were compared between the groups and correlated to age, diabetes duration, HbA1c and nerve conduction measurements.ResultsCompared to healthy controls, T1DM participants showed lower total ACE‐III (p= .028), memory (p= .013) and language scores (p= .028), together with longer reaction times in the N‐back task (p= .041). Subgroup analyses demonstrated lower memory scores in those with painless DPN compared with healthy controls (p= .013). No differences were observed between the three T1DM subgroups. Cognitive scores and clinical parameters were not associated.ConclusionsThis study supports the notion of cognitive alterations in T1DM and indicates that cognitive function is altered in T1DM regardless of underlying neuropathic complications. The memory domain appears altered in T1DM, particularly in those with painless DPN. Further studies are needed to verify the findings.