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Licensed Unlicensed Requires Authentication Published by De Gruyter May 5, 2023

Effect of metabolic control on cognitive functions in children and adolescents with type 1 diabetes mellitus

  • Şeyma Kar , Eren Er ORCID logo EMAIL logo , Aysun Ata , İpek İnal-Kaleli , Tuğçe Özcan , Sezen Köse , Burcu Özbaran , Günay Demir , Samim Özen , Şükran Darcan and Damla Gökşen

Abstract

Objectives

Neurocognitive functions of children with type 1 diabetes mellitus (T1D) are reported to be poorer than those of healthy peers. The aim was to investigate the effects of age of onset of diabetes, metabolic control, and type of insulin regimen on neurocognitive functions in children and adolescents with T1D.

Methods

Forty-seven children aged 6–18 years, with T1D for at least five years, were included. Children with a known psychiatric disorder or chronic diseases other than T1D were excluded. Intelligence via the Wechsler children’s intelligence scale (WISC-R), short-term memory via the audio-auditory digits form B (GISD-B) test, visual motor perception via the Bender Gestalt test, and attention via the Moxo continuous attention and performance test, timing, hyperactivity, and impulsivity (Moxo-dCPT) were assessed.

Results

Compared with the T1D group, healthy controls had higher scores in terms of verbal intelligence quotient (IQ), performance IQ, and total IQ mean scores on WISC-R (p=0.01, p=0.05 and p=0.01, respectively). On the MOXO-dCPT test, the T1D group had higher impulsivity compared to the control group (p=0.04). Verbal IQ was better in the moderate control group than in the poorer metabolic control (p=0.01). Patients with no history of diabetic ketoacidosis (DKA) had higher performance, verbal and total intelligence scores than the group with history of DKA.

Conclusions

Poor metabolic control and a history of DKA in children with T1D adversely affected neurocognitive functions. It would be beneficial to consider the assessment of neurocognitive functions in T1D and to take the necessary precautions in follow-up.


Corresponding author: Eren Er, MD, Pediatric Endocrinologist, Department of Pediatric Endocrinology and Diabetes, Ege University Faculty of Medicine, İzmir, Türkiye, E-mail:

Funding source: The University of Ege Scientific Research Projects Committee

Award Identifier / Grant number: TTU-2020-20979

  1. Research funding: This study was supported by the University of Ege ‘Scientific Research Projects Committee’ by Project code TTU-2020-20979.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. Wherrett, DK, Daneman, D. Prevention of type 1 diabetes. Endocrinol Metab Clin N Am 2009;38:777–90. https://doi.org/10.1016/j.ecl.2009.08.006.Search in Google Scholar PubMed PubMed Central

2. Insel, RA, Dunne, JL, Atkinson, MA, Chiang, JL, Dabelea, D, Gottlieb, PA, et al.. Staging presymptomatic type 1 diabetes: a scientific statement of jdrf, the endocrine society, and the American diabetes association. Diabetes Care 2015;38:1964–74. https://doi.org/10.2337/dc15-1419.Search in Google Scholar PubMed PubMed Central

3. He, J, Li, S, Liu, F, Zheng, H, Yan, X, Xie, Y, et al.. Glycemic control is related to cognitive dysfunction in Chinese children with type 1 diabetes mellitus. J Diabetes 2018;10:948–57. https://doi.org/10.1111/1753-0407.12775.Search in Google Scholar PubMed

4. Luchsinger, JA, Tang, MX, Stern, Y, Shea, S, Mayeux, R. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol 2001;154:635–41. https://doi.org/10.1093/aje/154.7.635.Search in Google Scholar PubMed

5. Rovet, J, Alvarez, M. Attentional functioning in children and adolescents with IDDM. Diabetes Care 1997;20:803–10. https://doi.org/10.2337/diacare.20.5.803.Search in Google Scholar PubMed

6. Rovet, JF, Ehrlich, RM. The effect of hypoglycemic seizures on cognitive function in children with diabetes: a 7-year prospective study. J Pediatr 1999;134:503–6. https://doi.org/10.1016/s0022-3476(99)70211-8.Search in Google Scholar PubMed

7. DiMeglio, LA, Acerini, CL, Codner, E, Craig, ME, Hofer, SE, Pillay, K, et al.. ISPAD clinical practice consensus guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018;19(27 Suppl):105–14. https://doi.org/10.1111/pedi.12737.Search in Google Scholar PubMed

8. American Diabetes Association Professional Practice Committee. 6. Glycemic targets: standards of medical care in diabetes—2022. Diabetes Care 2022;45:S83–96. https://doi.org/10.2337/dc22-S006.Search in Google Scholar PubMed

9. Musen, G, Jacobson, AM, Ryan, CM, Cleary, PA, Waberski, BH, Weinger, K, et al.. Impact of diabetes and its treatment on cognitive function among adolescents who participated in the diabetes control and complications trial. Diabetes Care 2008;31:1933–8. https://doi.org/10.2337/dc08-0607.Search in Google Scholar PubMed PubMed Central

10. Jaser, SS, Jordan, LC. Brain health in children with type 1 diabetes: risk and protective factors. Curr Diabetes Rep 2021;21. https://doi.org/10.1007/s11892-021-01380-w.Search in Google Scholar PubMed PubMed Central

11. Shehata, G, Eltayeb, A. Cognitive function and event-related potentials in children with type 1 diabetes mellitus. J Child Neurol 2010;25:469–74. https://doi.org/10.1177/0883073809341667.Search in Google Scholar PubMed

12. Ghetti, S, Lee, JK, Sims, CE, DeMaster, DM, Glaser, NS. Diabetic ketoacidosis and memory dysfunction in children with type 1 diabetes. J Pediatr 2010;156:109–14. https://doi.org/10.1016/j.jpeds.2009.07.054.Search in Google Scholar PubMed

13. Uluc, S, Oktem, F, Erden, G, Gencoz, T, Sezgin, N. Wechsler intelligence scale for children-IV: a new era for Turkey in evaluation of intelligence in the clinical context. In: Wechsler Çocuklar için Zeka Ölçegi-IV: Klinik bağlamda zekanin degerlendirilmesinde Türkiye için yeni bir dönem. Turk Psikoloji Yazilari 2011, vol 14, 49–57 pp. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc8&NEWS=N&AN=2012-02972-005.Search in Google Scholar

14. Sancak, A. Altı ile onbir yaşları arasında anksiyete bozukluğu olan çocuklarla dikkat eksikliği ve hiperaktivite bozukluğu olan çocukların WISC-R performans testlerinin karşılaştırılması. MS thesis. Maltepe Üniversitesi, Sosyal Bilimler Enstitüsü, 2006. Maltepe Üniversitesi, Sosyal Bilimler Enstitüsü 2006.Search in Google Scholar

15. Erden, G, Yalın, A. Öğrenme güçlüğü olan çocuklarin Görsel İşitsel Sayi Dizisi Testi (GİSD-A) örüntüleri. Türk Psikoloji Dergisi 2001.Search in Google Scholar

16. Karakaş, S, Yalın, A. Gorsel-Isitsel-Sayi-Dizileri-Testi-B-Formu-Toad. Türk Psikol Derg 1995;10:20–31.Search in Google Scholar

17. Brannigan, GG, Decker, SL. The bender-gestalt II. Am J Orthopsychiatry 2006;76:10–2. https://doi.org/10.1037/0002-9432.76.1.10.Search in Google Scholar PubMed

18. Lacks, PB, Newport, K. A comparison of scoring systems and level of scorer experience on the bender-gestalt test. J Pers Assess 1980;44:351–7. https://doi.org/10.1207/s15327752jpa4404_3.Search in Google Scholar PubMed

19. Mazzeschi, C, Lis, A. The Bender-Gestalt test: Koppitz's Developmental Scoring System administered to two samples of Italian preschool and primary school children. Percept Mot Skills 1999;88(3 Suppl):1235–44. https://doi.org/10.2466/pms.1999.88.3c.1235 Search in Google Scholar PubMed

20. Slobodin, O, Cassuto, H, Berger, I. Age-related changes in distractibility: developmental trajectory of sustained attention in ADHD. J Atten Disord 2018;22:1333–43. https://doi.org/10.1177/1087054715575066.Search in Google Scholar PubMed

21. Okumuş, G, Önal Sönmez, A, Kahyaoğlu, H, Erdoğan, A. Comparing moxo attention deficit hyperactivity test results and clinically diagnosed attention deficit hyperactivity disorder. J Soc Humanit Sci Res 2017;4:889–905.Search in Google Scholar

22. Malkoç, G, Kırnaz, S. Moxo sürekli performans testinin dikkat eksikliği ve hiperaktivite bozukluğunda değerlendirme aracı olarak kullanılması. İstanbul: İstanbul Ticaret Üniversitesi Sosyal Bilimler. Dergisi 2018.Search in Google Scholar

23. Rovet, J, Alvarez, M. Attentional functioning in children and adolescents with IDDM. Diabetes Care 1997;20:803–10. https://doi.org/10.2337/diacare.20.5.803.Search in Google Scholar PubMed

24. Ohmann, S, Popow, C, Rami, B, Knig, M, Blaas, S, Fliri, C, et al.. Cognitive functions and glycemic control in children and adolescents with type 1 diabetes. Psychol Med 2010;40:95–103. https://doi.org/10.1017/s0033291709005777.Search in Google Scholar PubMed

25. Tonoli, C, Heyman, E, Roelands, B, Pattyn, N, Buyse, L, Piacentini, MF, et al.. Type 1 diabetes-associated cognitive decline : a meta-analysis and update of the current literature. 2014;6:499–513https://doi.org/10.1111/1753-0407.12193.Search in Google Scholar PubMed

26. Mansur, RB, Lee, Y, Zhou, AJ, Carmona, NE, Cha, DS, Rosenblat, JD, et al.. Determinants of cognitive function in individuals with type 2 diabetes mellitus: a meta-analysis. Ann Clin Psychiatry 2018;30:38–50.Search in Google Scholar

27. Irwin, A, Igudesman, D, Crandell, J, Kichler, JC, Kahkoska, AR, Burger, K, et al.. Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the flexible lifestyles empowering change (FLEX) intervention trial. Pediatr Diabetes 2022;23:516–26. https://doi.org/10.1111/pedi.13334.Search in Google Scholar PubMed PubMed Central

28. Hadj-Abo, A, Enge, S, Rose, J, Kunte, H, Fleischhauer, M. Individual differences in impulsivity and need for cognition as potential risk or resilience factors of diabetes self-management and glycemic control. PloS one 2020;15:e0227995. https://doi.org/10.1371/journal.pone.0227995.Search in Google Scholar PubMed PubMed Central

29. Li, W, Huang, E, Gao, S. Type 1 diabetes mellitus and cognitive impairments: a systematic review. J Alzheim Dis 2017;57:29–36. https://doi.org/10.3233/jad-161250.Search in Google Scholar PubMed

30. Weinger, K, Jacobson, AM, Musen, G, Lyoo, IK, Ryan, CM, Jimerson, DC, et al.. The effects of type 1 diabetes on cerebral white matter. Diabetologia 2008;51:417–25. https://doi.org/10.1007/s00125-007-0904-9.Search in Google Scholar PubMed

31. Jessup, AB, Grimley, MB, Meyer, E, Gregory, P, Belger, A, Hoffman, WH, et al.. Neurocognitive function in young patients presenting with new-onset type 1 diabetes. J Clin Res Pediatr Endocrinoogy 2015;7:203–10. https://doi.org/10.4274/jcrpe.2158.Search in Google Scholar PubMed PubMed Central

32. Er, E, Ata, A, Evin, F, Altınok, YA, Demir, G, Özen, S, et al.. Glycated hemoglobin variability and microvascular complications in patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2020;33:1533–7. https://doi.org/10.1515/jpem-2020-0337.Search in Google Scholar PubMed

33. Scott, ES, McGrath, RT, Januszewski, AS, Calandro, D, Hardikar, AA, O’Neal, DN, et al.. HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment. BMJ Open 2019;9:1–8. https://doi.org/10.1136/bmjopen-2019-033059.Search in Google Scholar PubMed PubMed Central

34. Nunley, KA, Rosano, C, Ryan, CM, Jennings, JR, Aizenstein, HJ, Zgibor, JC, et al.. Clinically relevant cognitive impairment in Middle-Aged adults with childhood-onset type 1 diabetes. Diabetes Care 2015;38:1768–76. https://doi.org/10.2337/dc15-0041.Search in Google Scholar PubMed PubMed Central

35. Gaudieri, PA, Chen, R, Greer, TF, Holmes, CS. Cognitive function in children with type 1 diabetes. Diabetes Care 2008;31:1892–7. https://doi.org/10.2337/dc07-2132.Search in Google Scholar PubMed PubMed Central

36. Desrocher, M, Rovet, J. Neurocognitive correlates of type 1 diabetes mellitus in childhood. Child Neuropsychol 2004;10:36–52. https://doi.org/10.1076/chin.10.1.36.26241.Search in Google Scholar PubMed

37. Perantie, DC, Lim, A, Wu, J, Weaver, P, Warren, SL, Sadler, M, et al.. Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus. Pediatr Diabetes 2008;9:87–95. https://doi.org/10.1111/j.1399-5448.2007.00274.x.Search in Google Scholar PubMed

38. Moryś, JM, Kozera, GM, Neubauer-Geryk, J, Kruszewski, P, Wolnik, B, Nyka, WM, et al.. Statin use and cognitive impairment in patients with type 1 diabetes: an observational study. Clin Neuropharmacol 2016;39:182–7. https://doi.org/10.1097/wnf.0000000000000158.Search in Google Scholar

Received: 2023-01-19
Accepted: 2023-04-20
Published Online: 2023-05-05
Published in Print: 2023-07-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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