A Systematic Review and Meta-analysis of Executive Function Performance in Type 1 Diabetes Mellitus

Abstract

T1DM and its associated risk factors are related to subtle impairments across the inhibition, working memory, and set-shifting domains of EF. Lower EF may be a key factor contributing to behavioral and clinical problems experienced by individuals with T1DM.

ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

“…Chronic hyperglycemia has adverse effects on neurocognitive function and brain structure and development in children and adolescents with diabetes . Chronic hyperglycemia and wide glucose fluctuations during the years of rapid brain development affect brain structure and development, including impairment of the growth of the hippocampus.…”

“…Chronic hyperglycemia has adverse effects on neurocognitive function and brain structure and development in children and adolescents with diabetes. [13][14][15][16][17] Chronic hyperglycemia and wide glucose fluctuations during the years of rapid brain development affect brain structure and development, including impairment of the growth of the hippocampus. These observations call into question the prevalent practice of tolerating some hyperglycemia to minimize the risk of hypoglycemia in young children with T1D.…”

Structural core of the executive control network: A high angular resolution diffusion MRI study

“…It includes processes such as working memory, inhibition of prepotent responses, attentional control, planning and flexibility of switching between different goals. Deficits in EF are observed across many brain diseases such as schizophrenia, major depressive disorder and Alzheimer's disease (Guarino et al, ; Snyder, ; Vohringer et al, ), and EF performance has been demonstrated to be an important factor influencing outcomes across many medical conditions including chronic cardiovascular and metabolic conditions (Broadley, White, & Andrew, ; Eggermont et al, ; C. Vincent & Hall, ). EF contributes to the coordination of activities across a wide range of cortical and subcortical brain structures that would make them vulnerable to reduced communication efficiency.…”

Decreased Spontaneous Brain Activity and Functional Connectivity in Type 1 Diabetic Patients Without Microvascular Complications

“…T1DM patients are exposed to high (hyperglycemia) and low (hypoglycemia) blood glucose levels, and cumulative hyperglycemic exposure can lead to microvascular end-organ damage, such as retinopathy and nephropathy [1]. In addition to microvascular complications, T1DM has been linked with an increased risk of cognitive impairment, which primarily presents as a decrease in information processing speed, attention, and executive function [2][3][4]. This cognitive decline may be present as early as 2 years after diagnosis and persists well into adulthood and late life [5,6].…”

“…Fluid-attenuated inversion recovery (FLAIR) scans were also acquired with the following parameters: TR/TE=7000/120 . The functional images were obtained axially using a gradient echo-planar imaging sequence as follows: TR/TE=2000/30 ms; slices=36; thickness=4 mm; gap=0 mm; FOV=240 mm×240 mm; acquisition matrix=64×64; FA=90°; and voxel size=3.75×3.75×4.0 mm 3 . The SENSE is used for parallel imaging.…”