The Feasibility of Detecting Neuropsychologic and Neuroanatomic Effects of Type 1 Diabetes in Young Children

Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA.
Diabetes care (Impact Factor: 8.42). 06/2011; 34(7):1458-62. DOI: 10.2337/dc10-2164
Source: PubMed


To determine if frequent exposures to hypoglycemia and hyperglycemia during early childhood lead to neurocognitive deficits and changes in brain anatomy.
In this feasibility, cross-sectional study, young children, aged 3 to 10 years, with type 1 diabetes and age- and sex-matched healthy control (HC) subjects completed neuropsychologic (NP) testing and magnetic resonance imaging (MRI) scans of the brain.
NP testing and MRI scanning was successfully completed in 98% of the type 1 diabetic and 93% of the HC children. A significant negative relationship between HbA1c and Wechsler Intelligence Scale for Children (WISC) verbal comprehension was observed. WISC index scores were significantly reduced in type 1 diabetic subjects who had experienced seizures. White matter volume did not show the expected increase with age in children with type 1 diabetes compared with HC children (diagnosis by age interaction, P=0.005). A similar trend was detected for hippocampal volume. Children with type 1 diabetes who had experienced seizures showed significantly reduced gray matter and white matter volumes relative to children with type 1 diabetes who had not experienced seizures.
It is feasible to perform MRI and NP testing in young children with type 1 diabetes. Further, early signs of neuroanatomic variation may be present in this population. Larger cross-sectional and longitudinal studies of neurocognitive function and neuroanatomy are needed to define the effect of type 1 diabetes on the developing brain.

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    • "It is noteworthy that Hoffman et al. have reported that autophagy is increased in the brains of young T1D patients with chronic poor metabolic control and increased oxidative stress [116]. Moreover, the finding of significant expression of autophagic markers in both white and gray matter is in keeping with the structural deficits in young patients with T1D [117, 118] and the white matter atrophy in the frontal and temporal regions in these diabetic ketoacidosis cases [104]. However there are still few studies focusing on the role of autophagy in the brains of T1D patients, and therefore further research is needed on the relationship between autophagy and pathogenesis of early onset diabetic encephalopathy in T1D. "
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    • "The clinical significance of the findings is uncertain, given the modest effects. Nonetheless, the findings are in keeping with Aye et al. (2011). Together, results suggest that cognitive differences may emerge in young children with T1D, even after relatively short disease duration. "
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