Cognitive Functioning in Young Children with Type 1 Diabetes

Cato, M. Allison; Mauras, Nelly; Ambrosino, Jodie M.; Bondurant, Aiden; Conrad, Amy L.; Kollman, Craig; Cheng, Peiyao; Beck, Roy W.; Ruedy, Katrina J.; Aye, Tandy; Reiss, Allan L.; White, Neil H.; Hershey, Tamara

doi:10.1017/s1355617713001434

Cited by 81 publications

(94 citation statements)

References 41 publications

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“…In the neuro-imaging and neuro-cognitive portions of our study, subtle cognitive differences were present in the children with T1D compared with age-matched healthy controls despite relatively short T1D duration (5). Significant differences in brain gray matter volumes (3) and white matter microstructure (12) in widespread brain regions also were observed; these differences were primarily associated with hyperglycemia.…”

Section: Discussionmentioning

confidence: 71%

Persistently high glucose levels in young children with type 1 diabetes

et al. 2014

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Objectives To characterize glucose levels and variability in young children with T1D. Methods 144 children ages 4–10 diagnosed with T1D prior to age 8 were recruited at 5 DirecNet centers. Participants used a continuous glucose monitor (CGM) every 3 months during an 18-month study. Among the 144 participants, 135 (mean age 7.0 years, 47% female) had a minimum of 48 hours of CGM data at >5 out of 7 visits and were included in analyses. CGM metrics for different times of day were analyzed. Results Mean HbA1c at the beginning and end of the study was 7.9% (63 mmol/mol). Fifty percent of participants had glucose levels >180mg/dL (10.0 mmol/L) for >12 hours/day and >250 mg/dL (13.9 mmol/L) for >6 hours/day. Median time <70 mg/dL (3.9 mmol/L) was 66 minutes/day and <60 mg/dL (3.3 mmol/L) was 39 minutes/day. Mean amplitude of glycemic excursions (MAGE) was lowest overnight (12AM–6AM). The percent of CGM values 71–180 mg/dL (3.9–10.0 mmol/L) and the overall mean glucose correlated with HbA1c at all visits. There were no differences in CGM mean glucose or coefficient of variation between the age groups of 4–<6, 6–<8 and 8–<10. Conclusions Suboptimal glycemic control is common in young children with T1D as reflected by glucose levels in the hyperglycemic range for much of the day. New approaches to reduce postprandial glycemic excursions and increase time in the normal range for glucose in young children with T1D are critically needed. Glycemic targets in this age range should be revisited.

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Section: Discussionmentioning

confidence: 71%

Persistently high glucose levels in young children with type 1 diabetes

et al. 2014

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“…Other current reports in children and adults support the achievement of an HbA 1c <7% (<53 mmol/mol) or <7.5% (<58 mmol/mol) without an increase in SH [11,12,20]. There is an increasing body of evidence that DKA and hyperglycaemia per se, in addition to hypoglycaemia, can have adverse effects on the developing brains of young children [21][22][23]. Thus, it is particularly noteworthy with respect to safety concerns that better HbA 1c outcomes in the DPV registry were associated with a lower frequency of DKA.…”

Section: Discussionmentioning

confidence: 95%

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

Maahs

Hermann

DuBose³

et al. 2014

Diabetologia

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154

137

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DPV data indicate that an HbA1c of <7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA1c targets that are recommended for this age group in the USA.

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“…Details of the study participants have been previously reported (23–25,34). In brief, children with diabetes ( N = 144) and healthy control subjects without diabetes ( N = 72) between 4 and 10 years of age (mean age at study entry 7.0 years) were recruited for the study, and 210 participants (children with diabetes N = 141, control subjects N = 69) were successfully imaged at both time points.…”

Section: Methodsmentioning

confidence: 99%

“…At study enrollment and after 18 months, all subjects underwent brain imaging and neurocognitive testing (34). Glycemic measures were assessed every 3 months in the group with diabetes.…”

Section: Methodsmentioning

confidence: 99%

Variations in Brain Volume and Growth in Young Children With Type 1 Diabetes

et al. 2015

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Early-onset type 1 diabetes may affect the developing brain during a critical window of rapid brain maturation. Structural MRI was performed on 141 children with diabetes (4–10 years of age at study entry) and 69 age-matched control subjects at two time points spaced 18 months apart. For the children with diabetes, the mean (±SD) HbA1c level was 7.9 ± 0.9% (63 ± 9.8 mmol/mol) at both time points. Relative to control subjects, children with diabetes had significantly less growth of cortical gray matter volume and cortical surface area and significantly less growth of white matter volume throughout the cortex and cerebellum. For the population with diabetes, the change in the blood glucose level at the time of scan across longitudinal time points was negatively correlated with the change in gray and white matter volumes, suggesting that fluctuating glucose levels in children with diabetes may be associated with corresponding fluctuations in brain volume. In addition, measures of hyperglycemia and glycemic variation were significantly negatively correlated with the development of surface curvature. These results demonstrate that early-onset type 1 diabetes has widespread effects on the growth of gray and white matter in children whose blood glucose levels are well within the current treatment guidelines for the management of diabetes.

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Cognitive Functioning in Young Children with Type 1 Diabetes

Cited by 81 publications

References 41 publications

Persistently high glucose levels in young children with type 1 diabetes

Persistently high glucose levels in young children with type 1 diabetes

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

Variations in Brain Volume and Growth in Young Children With Type 1 Diabetes

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