Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

Department of Psychology, Royal Children's Hospital, Melbourne, Parkville, Victoria 3052, Australia.
Diabetes Care (Impact Factor: 8.42). 10/2001; 24(9):1541-6. DOI: 10.2337/diacare.24.9.1541
Source: PubMed


To describe neuropsychological profiles and their relationship to metabolic control in children with type 1 diabetes 6 years after the onset of disease.
Children with type 1 diabetes (n = 90), aged 6-17 years, who had previously been assessed soon after diagnosis and 2 years later, were reevaluated 6 years after the onset of disease. Their neuropsychological profiles were compared with those of individuals in a community control group (n = 84), who had been assessed at similar intervals. Relationships between illness variables, such as age at the onset of disease and metabolic control history, and neuropsychological status were also examined.
Six years after onset of disease, children with type 1 diabetes performed more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills. Attention, processing speed, and executive skills were particularly affected in children with onset of disease before 4 years of age, whereas severe hypoglycemia was associated with lower verbal and full-scale intelligence quotient scores.
Neuropsychological profiles of children with type 1 diabetes 6 years after the onset of disease are consistent with subtle compromise of anterior and medial temporal brain regions. Severe hypoglycemia, particularly in very young children, is the most plausible explanation for neuropsychological deficits, but the contributory role of chronic hyperglycemia warrants further exploration.

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Available from: George Werther, Jan 28, 2016
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    • "In this sense, tight regulation of insulin levels seems to be mandatory to regulate central function. Central nervous system insulin receptors are highly expressed in regions associated to learning and memory, such as the cortex and the hippocampus and previous studies have reported that cognition impairment detected in type 1 diabetic children, might be related to hypoinsulinemia (Northam et al., 2001; Schoenle et al., 2002). Also, AD brains present lower insulin levels and higher insulin receptors density when compared to control patients (for review see (El Khoury et al., 2014)). "
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    • "Lastly, although it is not the focus of this review, another variable to be considered is the possibility of hypoglycemic episodes occurring within a context of hyperglycemia resulting from inappropriate insulin treatment, since it must be considered that acute [119, 120] and chronic [121–124] hyperglycemia, gestational hyperglycemia [125], and glycemic variability [126, 127] can also contribute towards the reduction of cognitive performance, since the excess of glucose can lead to brain damage regardless of the occurrence of IIH [128]. Moreover, studies in laboratory animals suggest that hyperglycemia after hypoglycemia, a condition frequent in poorly controlled diabetes, would lead to more neuronal death than isolated hypoglycemia [129]. "
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    ABSTRACT: This paper provides an overview of insulin-induced hypoglycemia as a triggering factor of cognitive deficit in children with type 1 diabetes mellitus. For this purpose, databases from 1961 to 2013 were used with the objective of detecting the primary publications that address the impact of hypoglycemia on cognitive performance of diabetic children. The results obtained from experimental animals were excluded. The majority of studies demonstrated that the cognitive deficit in diabetic children involves multiple factors including duration, intensity, severity, and frequency of hypoglycemia episodes. Additionally, age at the onset of type 1 diabetes also influences the cognitive performance, considering that early inception of the disease is a predisposing factor for severe hypoglycemia. Furthermore, the results suggest that there is a strong correlation between brain damage caused by hypoglycemia and cognitive deterioration. Therefore, a more cautious follow-up and education are needed to impede and treat hypoglycemia in children with diabetes mellitus.
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    • "E-mail: White, 1997; Hershey, Lillie, Sadler, & White, 2003, 2004; Hershey et al., 2005; Lin et al., 2010; Naguib, Kulinskaya, Lomax, & Garralda, 2009; Northam et al., 2001; Perantie et al., 2008; Rovet & Ehrlich, 1999) or brain changes (Ferguson et al., 2003; Haumont, Dorchy, & Pelc, 1979; Hyllienmark, Maltez, Dandenell, Luvigsson, & Brismar, 2005; Musen et al., 2006; Northam et al., 2009; Perantie et al., 2011, 2007; Perros, Deary, Sellar, Best, & Frier, 1997). There is preliminary evidence to suggest that this association can be detected quite early in young children and youth with recent onset diabetes (Aye et al., 2011). "
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