RT Journal Article
SR Electronic
T1 Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP dc202125
DO 10.2337/dc20-2125
A1 Mauras, Nelly
A1 Buckingham, Bruce
A1 White, Neil H.
A1 Tsalikian, Eva
A1 Weinzimer, Stuart A.
A1 Jo, Booil
A1 Cato, Allison
A1 Fox, Larry A.
A1 Aye, Tandy
A1 Arbelaez, Ana Maria
A1 Hershey, Tamara
A1 Tansey, Michael
A1 Tamborlane, William
A1 Foland-Ross, Lara C.
A1 Shen, Hanyang
A1 Englert, Kimberly
A1 Mazaika, Paul
A1 Marzelli, Matthew
A1 Reiss, Allan L.
A1 ,
YR 2021
UL http://care.diabetesjournals.org/content/early/2021/01/28/dc20-2125.abstract
AB OBJECTIVE To assess whether previously observed brain and cognitive differences between children with type 1 diabetes and control subjects without diabetes persist, worsen, or improve as children grow into puberty and whether differences are associated with hyperglycemia.RESEARCH DESIGN AND METHODS One hundred forty-four children with type 1 diabetes and 72 age-matched control subjects without diabetes (mean ± SD age at baseline 7.0 ± 1.7 years, 46% female) had unsedated MRI and cognitive testing up to four times over 6.4 ± 0.4 (range 5.3–7.8) years; HbA1c and continuous glucose monitoring were done quarterly. FreeSurfer-derived brain volumes and cognitive metrics assessed longitudinally were compared between groups using mixed-effects models at 6, 8, 10, and 12 years. Correlations with glycemia were performed.RESULTS Total brain, gray, and white matter volumes and full-scale and verbal intelligence quotients (IQs) were lower in the diabetes group at 6, 8, 10, and 12 years, with estimated group differences in full-scale IQ of −4.15, −3.81, −3.46, −3.11, respectively (P < 0.05), and total brain volume differences of −15,410, −21,159, −25,548, −28,577 mm3 × 103 at 6, 8, 10, and 12 years, respectively (P < 0.05). Differences at baseline persisted or increased over time, and brain volumes and cognitive scores negatively correlated with a life-long HbA1c index and higher sensor glucose in diabetes.CONCLUSIONS Detectable changes in brain volumes and cognitive scores persist over time in children with early-onset type 1 diabetes followed longitudinally; these differences are associated with metrics of hyperglycemia. Whether these changes can be reversed with scrupulous diabetes control requires further study. These longitudinal data support the hypothesis that the brain is a target of diabetes complications in young children.