Previous studies have shown that recurrent severe hypoglycaemia can cause long-term cognitive impairment in children with type-1 diabetes, but the results are controversial, possibly due to the heterogeneity of samples and lack of comprehensive neuropsychological assessments of children. The aim of this study was to assess the effects of diabetes and severe hypoglycaemia on the neurocognitive functioning of children with a standardized, wide age-range neuropsychological test battery designed for the assessment of children. Eleven children with diabetes and a history of severe hypoglycaemia, 10 children with diabetes without a history of severe hypoglycaemia, and 10 healthy control children (a total of 31 children: 14 males and 17 females, age range 5 years 6 months to 11 years 11 months, mean 9 years 4 months, SD 1 year 11 months) were studied using the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the NEPSY, a Developmental Neuropsychological Assessment. The NEPSY assessed development in attention and executive functions, language, sensorimotor functions, visuospatial processing, and learning and memory. Children with a history of severe hypoglycaemia had more neuropsychological impairments, more learning difficulties (as reported by parents), and needed more part-time special education than those in the other groups. Significant differences were found in verbal short-term memory and phonological processing. Results suggest that severe hypoglycaemia is a risk factor for learning due to deficits in auditory-verbal functioning.

DKA Diabetic ketoacidosis GLM General linear model T1DM Type 1 diabetes mellitusAIM The study aimed to assess the effects of diabetes-related risk factors, especially severe hypoglycaemia, on the academic skills of children with early-onset type 1 diabetes mellitus (T1DM). METHODThe study comprised 63 children with T1DM (31 females, 32 males; mean age 9y 11mo, SD 4mo) and 92 comparison children without diabetes (40 females, 52 males; mean age 9y 9mo, SD 3mo). Children were included if T1DM had been diagnosed before the age of 5 years and if they were aged between 9 and 10 years at the time of study. Children were not included if their native language was not Finnish and if they had a diagnosed neurological disorder that affected their cognitive development. Among the T1DM group, 37 had and 26 had not experienced severe hypoglycaemia and 26 had avoided severe hypoglycaemia. Severe hypoglycaemia, diabetic ketoacidosis (DKA), and glycaemic control were used as T1DM-related factors. Task performance in reading, spelling, and mathematics was compared among the three groups, and the effects of the T1DM-related factors were analysed with general linear models. RESULTSThe groups with (p<0.001) and without (p=0.001) severe hypoglycaemia demonstrated a poorer performance than the comparison group in spelling, and the group without severe hypoglycaemia showed a poorer performance than the comparison group in mathematics (p=0.003). Severe hypoglycaemia, DKA, and recent glycaemic control were not associated with poorer skills, but poorer first-year glycaemic control was associated with poorer spelling (p=0.013).INTERPRETATION An early onset of T1DM can increase the risk of learning problems, independently of the history of severe hypoglycaemia or DKA. Poorer glycaemic control after the first year of T1DM is associated with a poorer acquisition of academic skills indicating the effect of the timing of metabolic aberrations on cognitive development.An association between early-onset type 1 diabetes mellitus (T1DM) and cognitive and neural dysfunction has been demonstrated.1 However, the mechanism underlying deficient neurodevelopment remains unclear. Hypotheses have been proposed concerning the effect of extreme levels of plasma glucose on brain metabolism and neural functioning. In addition, the timing of the metabolic insult in a child's development seems to be an important predictor of the outcome. 1,2Children with an earlier onset of T1DM have lower cognitive and academic skills than those with later onset T1DM or healthy children. 3In addition to the early onset of T1DM, several risk factors, in particular severe hypoglycaemia 4-7 and prolonged hyperglycaemia, 4,7,8 have been shown to affect cognitive development. The interaction of an early age at onset of T1DM and extreme levels of plasma glucose at an early age is proposed to have the most detrimental effect on cognitive development.

Previous studies have shown that recurrent severe hypoglycaemia can cause long‐term cognitive impairment in children with type‐1 diabetes, but the results are controversial, possibly due to the heterogeneity of samples and lack of comprehensive neuropsychological assessments of children. The aim of this study was to assess the effects of diabetes and severe hypoglycaemia on the neurocognitive functioning of children with a standardized, wide age‐range neuropsychological test battery designed for the assessment of children. Eleven children with diabetes and a history of severe hypoglycaemia, 10 children with diabetes without a history of severe hypoglycaemia, and 10 healthy control children (a total of 31 children: 14 males and 17 females, age range 5 years 6 months to 11 years 11 months, mean 9 years 4 months, SD 1 year 11 months) were studied using the Wechsler Intelligence Scale for Children‐Revised (WISC‐R) and the NEPSY, a Developmental Neuropsychological Assessment. The NEPSY assessed development in attention and executive functions, language, sensorimotor functions, visuospatial processing, and learning and memory. Children with a history of severe hypoglycaemia had more neuropsychological impairments, more learning difficulties (as reported by parents), and needed more part‐time special education than those in the other groups. Significant differences were found in verbal short‐term memory and phonological processing. Results suggest that severe hypoglycaemia is a risk factor for learning due to deficits in auditory‐verbal functioning.

AIM Basic verbal and academic skills can be adversely affected by early-onset diabetes, although these skills have been studied less than other cognitive functions. This study aimed to explore the mechanism of learning deficits in children with diabetes by assessing basic verbal and academic skills in children with early-onset diabetes and in comparison children. In addition, the incidence of dyslexia (£10th centile in reading speed or reading-spelling accuracy) was studied.METHOD The performance of 51 children with early-onset diabetes (25 females, 26 males; mean age 9y 11mo, SD 4mo; range 9-10y) was compared with that of 92 children without diabetes (40 females, 52 males; mean age 9y 10mo, SD 3mo; range 9-10y) in the tasks of phonological processing, short-term memory, rapid automatized naming, reading, spelling, and mathematics. RESULTSThe performance of children with diabetes was poorer than that of the comparison children in phonological processing (p=0.001), spelling accuracy (p<0.001), and mathematics (p=0.024). They learned to read later (p=0.013), but reading performance and the incidence of dyslexia in the third grade (aged 9-10y) were similar in the two groups.INTERPRETATION Children with early-onset diabetes are prone to minor learning difficulties in their early school years as a result of deficits in phonological processing.Cognitive development may be affected in children with type 1 diabetes. Among the variables related to this illness, early age at onset shows the strongest effect on cognitive development, whereas the role of severe hypoglycaemia and other complications is more controversial. 1 It has been proposed that developing skills are vulnerable to brain insults, for example as a result of extreme fluctuations in blood glucose. 2 For this reason, basic cognitive functions that develop during early childhood, and the emerging skills dependent on them, are prone to be affected in early-onset diabetes. Research on the basic cognitive functions should, therefore, add essential information about the possible mechanism of learning deficits in children with diabetes.Previous research into the cognitive functions of children with diabetes has focused on intelligence, learning and memory, processing speed, and attention. 1 Among verbal skills, the focus has been on complex skills such as verbal intelligence 3,4 and verbal learning and memory. 4,5 Prospective studies have shown problems in the development of verbal intelligence as a function of severe hypoglycaemia, 3,4 which increase with the duration of illness, whereas the findings of cross-sectional studies have been more inconclusive, probably because of large differences in the age of the sample populations and different methods of assessment.Basic verbal skills have been assessed in only a few studies, and deficits in auditory short-term memory 6-9 and phonological processing 9 have been reported in some children with diabetes. Rapid automatized naming has not been assessed in children with diabetes, although it is an important measure of la...

Aim To examine the hypoglycaemic effect on neurodevelopmental outcome in patients with transient and persistent congenital hyperinsulinism (CHI) born in the 21st century. Method A cohort of 117 patients (66 males, 51 females) with CHI aged 5 to 16 years (mean age 8y 11mo, SD 2y 7mo) were selected from a Finnish nationwide registry to examine all the patients with similar methods. Neurodevelopment was first evaluated retrospectively. The 83 patients with no risk factors for neurological impairment other than hypoglycaemia were recruited and 44 participated (24 males, 20 females; mean age 9y 7mo, SD 3y 1mo) in neuropsychological assessment with the Wechsler Intelligence Scale for Children, Fourth Edition and the Finnish version of the Developmental Neuropsychological Assessment, Second Edition domains of attention, language, memory, sensorimotor, and visual functioning. Results In retrospective analysis, transient and persistent CHI groups had similar prevalences of mild (22% and 18% respectively) or severe (5% and 7% respectively) neurodevelopmental difficulties. In clinical assessment, the neurocognitive profile was within the average range in both groups, but children with persistent CHI showed significant but restricted deficits in attention, memory, visual, and sensorimotor functions compared with the general population. The transient CHI group did not differ from the standardization samples. Interpretation Besides the more apparent broader neurological deficits, children with persistent CHI have an increased risk for milder specific neurocognitive problems, which should be considered in the follow‐up. What this paper adds Children with persistent congenital hyperinsulinism showed deficits in attention, memory, visual, and sensorimotor functions. The deficits were potentially of hypoglycaemic origin. Children with transient hyperinsulinism did not differ from the general population.

Mild abnormal findings in brain perfusion, the EEG and in cognitive processing are common in children with type 1 diabetes, but these abnormalities are not associated with previous severe hypoglycaemia.We studied the effect of diabetes on long-term brain function by comparing two age-matched groups of normally developed prepubertal type 1 diabetes children (age 5.6-11.9 years, diabetes duration 1.8-9.6 years). Of the 20 patients, 10 had experienced severe hypoglycaemia leading to unconsciousness and/or convulsions. All patients were in normal school or preschool. Their mean HbA1c ± SD was 8.4±1.7% (reference range 4.0%-6.2%). For every patient, we performed within 1 month (1) cerebral blood flow detected by single-photon emission tomography (SPECT) without anaesthesia, (2) brain electrical activity detected by 8-channel EEG, and (3) cognitive function evaluated by comprehensive neuropsychological assessment. The blood glucose level of the patients was measured before each study session to avoid hypoglycaemia.In the SPECT analysis, transaxial slices were reconstructed at three levels: canto-meatal line (CM) +36 mm, 48 mm, and 64 mm. Six symmetrical cortical regions of interest (ROI) were drawn on each hemisphere and labelled from the frontal to the occipital as ROIs 1 to 6 [3]. The average radioactivity of each region and hemisphere was measured and the left-right index was calculated for each ROI and hemisphere (2 · (left-right)/(left + right)), where left and right represent the average radioactivities of two symmetrical ROIs in each hemisphere. Data from the literature were used for normal cerebral blood flow [1]. EEGs were analysed visually and semiquantitatively and scored 0-5 according to amount of background slowing, paroxysmality, and focal abnormalities.Intelligence was assessed with The Wechsler Intelligence Scale for Children-Revised (WISC-R) [4] or Wechsler Preschool and Primary Scale of IntelligenceRevised (WPPSI-R) [5]. Cognitive functions were evaluated with The Developmental Neuropsychological Assessment (NEPSY) [2] in five domains (Table 1). Of the 30 NEPSY tests, 16 were administered.The left-right indexes in SPECT were tested both between the groups and against zero with the Student t-test. According to power-analysis, the number of subjects in each group was sufficient to detect a difference of 0.05 in the left-right index. Fisher's exact test was used for comparison of EEGs. The Student t-test and the v 2 test were used to determine group differences in the neuropsychological study. P values <0.05 were considered significant.The left-right index of the hemispheres in both groups was negative. These results differ from those of normal children, in whom the left cerebral blood flow values are significantly higher than the right values [1]. The left-right index of the hemispheres of the two groups did not differ from each other. However, the hypoglycaemic patients had significantly more ROIs where the left-right index exceeded the average +2SD than did the other patients (9 versus 2, the number o...

Children with early-onset diabetes faced an increased risk of internalising problems in middle childhood. The mothers' psychological distress was associated with children's behaviour problems rather than their diabetes.

The purpose of this study is to examine differences in parenting styles between mothers of children with type 1 diabetes and mothers of healthy children and to explore relationships between parenting styles and glycemic control of children with diabetes. Mothers of 63 children with diabetes and mothers of 83 children without diabetes reported their parenting styles using the Blocks’ Child Rearing Practices Report, when their child was 9–10 years old. Glycemic control of the children with diabetes was evaluated 1 year after diagnosis (<6 years of age) and at the time of the study (at 9–10 years). Mothers of children with diabetes used more psychological control than mothers of healthy children. Among girls with diabetes, poorer early glycemic control was associated with mothers’ subsequent greater use of psychological control. Behavioral control was positively associated with poorer current glycemic control. In boys, psychological control was positively associated with poorer current glycemic control. Psychological control in families with diabetes needs attention, because it has shown to be associated with poorer diabetes care.