Hyperglycemia in Childhood T1D Associated With Small but Notable Functional Deficits

Developing brains are negatively impacted by episodes of hyperglycemia in type 1 diabetes, and small but notable functional deficits have been identified, according to research presented at ENDO 2021, held virtually March 20 to 23, 2021.

Using data from the Diabetes Research in Children Network, researchers conducted longitudinal studies on the cognitive and neurodevelopmental consequences of type 1 diabetes in children and age-matched controls without diabetes.

Previous research has shown that severe hypoglycemia and chronic hyperglycemia can both affect the developing brain. Researchers used structural magnetic resonance imaging and age-appropriate cognitive testing to evaluate potential changes.

The cohort included 144 children with type 1 diabetes between 4 and 9 years of age at the start of the study and 70 age-matched controls. Children were evaluated at 4 points over a 6- to 7-year follow-up period that included puberty.

Significant differences were observed in total brain, grey matter, and white matter volume, as well as white matter microstructure alterations, in the type 1 diabetes group compared with the control group. Slower brain growth was also noted after 18 months of follow-up.

According to study investigators, these differences persisted over the long term and were “highly correlated” with metrics of hyperglycemia, including hemoglobin A1c, lifetime A1c, and percent sensor glucose >180 mg/dL, among others. Longitudinal follow-up maintained through puberty indicated that children with type 1 diabetes also had lower full-scale and verbal IQ scores.

Results of functional brain imaging during a series of increasingly complex cognitive tasks were comparable between both groups; however, brain patterns indicated increased activation of executive control areas in type 1 diabetes.

“The brain is a target of diabetes complications and hyperglycemia can be detrimental to the developing brain, particularly in young children,” the researchers concluded. “Although the functional impact is so far small, long-term data are needed. Whether improved glycemic control could impact these trajectories requires further study.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Mauras N. Longitudinal structural, functional, and cognitive impact of type 1 diabetes on the brain in children. Presented at: ENDO 2021; March 20-23, 2021. Session S46.