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Longitudinal Evaluation of Cognitive Functioning in Young Children with Type 1 Diabetes over 18 Months

Published online by Cambridge University Press:  20 January 2016

M. Allison Cato*
Affiliation:
Division of Neurology, Nemours Children’s Health System, Jacksonville, Florida
Nelly Mauras
Affiliation:
Division of Endocrinology, Nemours Children’s Health System, Jacksonville, Florida
Paul Mazaika
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
Craig Kollman
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Peiyao Cheng
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Tandy Aye
Affiliation:
Division of Pediatrics Endocrinology and Diabetes, Stanford University, Stanford, California
Jodie Ambrosino
Affiliation:
Yale Children’s Diabetes Program, Yale University, New Haven, Connecticut
Roy W. Beck
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Katrina J. Ruedy
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Allan L. Reiss
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California Department of Radiology, Stanford University, Stanford, California Department of Pediatrics, Stanford University, Stanford, California
Michael Tansey
Affiliation:
Division of Pediatric Psychology, University of Iowa Children’s Hospital, Iowa City, Iowa
Neil H. White
Affiliation:
Departments of Pediatrics, Washington University, St. Louis, Missouri
Tamara Hershey
Affiliation:
Department of Psychiatry, Washington University, St. Louis, Missouri Department of Neurology, Washington University, St. Louis, Missouri Department of Radiology, Washington University, St. Louis, Missouri
*Corresponding
Correspondence and reprint requests to: M. Allison Cato, Nemours Children’s Health System, Neurology Division, 807 Children’s Way, Jacksonville, FL 32207. E-mail: acato@nemours.org

Abstract

Objectives: Decrements in cognitive function may already be evident in young children with type 1 diabetes (T1D). Here we report prospectively acquired cognitive results over 18 months in a large cohort of young children with and without T1D. Methods: A total of 144 children with T1D (mean HbA1c: 7.9%) and 70 age-matched healthy controls (mean age both groups 8.5 years; median diabetes duration 3.9 years; mean age of onset 4.1 years) underwent neuropsychological testing at baseline and after 18-months of follow-up. We hypothesized that group differences observed at baseline would be more pronounced after 18 months, particularly in those T1D patients with greatest exposure to glycemic extremes. Results: Cognitive domain scores did not differ between groups at the 18 month testing session and did not change differently between groups over the follow-up period. However, within the T1D group, a history of diabetic ketoacidosis (DKA) was correlated with lower Verbal IQ and greater hyperglycemia exposure (HbA1c area under the curve) was inversely correlated to executive functions test performance. In addition, those with a history of both types of exposure performed most poorly on measures of executive function. Conclusions: The subtle cognitive differences between T1D children and nondiabetic controls observed at baseline were not observed 18 months later. Within the T1D group, as at baseline, relationships between cognition (Verbal IQ and executive functions) and glycemic variables (chronic hyperglycemia and DKA history) were evident. Continued longitudinal study of this T1D cohort and their carefully matched healthy comparison group is planned. (JINS, 2016, 21, 293–302)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2016 

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Footnotes

*

A full listing of the members of the study group is included in the acknowledgments.

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